The VBAC Controversy (Vaginal Birth After Cesarean)

Posted: 1864 days ago in Parenting

vbac

Have you ever heard the insider’s statement, “Once a C-section, always a C-section.” If you’ve heard it, do you believe that it’s true? Well, in most cases, it’s no longer true.

Let me tell you why.

In years past, Cesarean section births required an incision that ran vertically, from the belly button down to the pubic bone. You’ve seen them, haven’t you? That incision cut through all of the contractile fibers of the uterus, which made it subject to rupture during subsequent pregnancies. A possibility that was not safe for mom or baby, so it’s clear why women with those incisions should not try to have a vaginal birth.

Now the good news:

In the past few decades, surgical techniques have improved, and c-section incisions are now made horizontally, way down near the pubic area. The fibers of the uterus don’t contract much, if at all down there, so barring any other factors, there is no reason why a woman with a C-section should not be allowed to attempt at least of trial of labor.

scars
The ideal VBAC scenario?

You are more likely to have a successful VBAC if you’ve had a prior vaginal delivery, go into labor naturally, have had only one prior c-section, and the reason for that surgery no longer exists.

Here are some of the other factors that may impact a woman’s ability to have a VBAC:

  • Position of baby: If a baby remains breech as delivery approaches, it would be unwise to plan on a vaginal delivery. Chiropractic helps A LOT to normalize position of mom’s pelvic bones to encourage baby to turn into the head-down position that is required for vaginal birth.
  • Placental issues: If the placenta lies too close to the cervix, or is vulnerable to bleeding, a C-section may be the only option.
  • Induction of labor: The use of any medications to induce labor rules out potential for VBAC, as the contractions that these medications stimulate are significantly stronger than natural contractions and may challenge the prior scar.

So if these factors have been ruled out, why don’t more women have VBAC’s?

Scheduled C-sections are a very controllable way to give birth. Doctors and/or parents may be more comfortable managing birth that way by picking a time, and place. But are those reasons good enough?

It is clear that vaginal birth is best for baby and mom – if you’d like more info on that, check out my post, “Three Reasons You Must Avoid a C-Section”. I got a lot of… ahem… love notes after that piece ran, so let me state again what I made clear the first time I ran that piece: AS LONG AS MOM AND BABY ARE HEALTHY AND SHOWING NO SIGNS OF DISTRESS, VAGINAL BIRTH IS BEST.

If you’ve had a C-section and would like to attempt a VBAC, talk with your prenatal caregiver about your particular situation, and see if you can join the many women who are able to successfully have a Vaginal Birth After Cesarean.

Want some more info on the pros and cons of VBAC? Here ya go!

The Best Laid Birth Plans

Posted: 1907 days ago in Parenting

bestlaidbirthplans

I am a planner. And a list maker. So why should my labor and delivery be any different?

My name is Dr. Tania and yes, I did make a birth plan.

And by birth plan, I mean that I did a lot of research, and came up with a list of must haves, a list of definitely not’s, and a whole lot of room for variation.

You may be like some of my patients who write a multi-page plan in triplicate, which you then submit to your doctors and place of birth. Or, you may be on the other end of the spectrum and just go with the flow, and address issues if and when they arise.

Me, I landed somewhere in the middle…

  • I knew that I wanted to labor at home and deliver in a birth center.
  • I knew that I wanted the freedom to move around, float in a tub and have a light snack.
  • I knew that I wanted to avoid an IV and pain management medications.
  • I knew that I wanted to wait for the umbilical cord to stop pulsating before it was cut, and baby to be on my chest for as long as I wanted her there.

And I wanted my baby to be safe and healthy, so if my ‘birth plan’ went to hell in a handbasket to ensure a healthy baby and me, then so be it. I’d much rather my baby and I be alive, than right.

You can’t mandate how your labor and delivery will go, but you can and should discuss the issues that are important to you with your caregivers. Whether you’re a fan of birth plans or not, I can assure you that you will not be in any frame of mind to make important decisions in the throws of labor. So if you have strong ideas about how you would like to be treated, make them known, have an advocate (like your hubby or friend) in the room with you, and call it what you will.

Best case? It all works out the way you hoped.heart

Wishing you all a happy, healthy birth and delivery.

Can You Crack a Walnut with YOUR Va-Jay-Jay?

Posted: 2112 days ago in Wellness

crackawalnutKegel, Schmegel. Ladies of all ages need to be concerned with their perineum.

Peri-what-um,” you say?! Your perineum, or “undercarriage” is where all of the genitals, bladder and rectum exit your body. A healthy perineum takes some attention, and if you ignore it, it can rebel by gifting you with things like incontinence, hemorrhoids and uterine prolapse. Not. Fun.

So, what is the proper care and feeding of your perineum?

Doing Kegel exercises regularly (and properly!) can definitely result in healthy muscle tone (Check out this page courtesy of Wikihow for more detailed exercises). Working on your perineum needn’t be a full-time job, either. You can Kegel at every stoplight or while waiting in line at the bank.

Sitting on an exercise ball instead of a chair is also kinder to your vagina. As you subtly rock and shift on the ball, it stretches and massages those delicate areas. So, trade in your office chair for an exercise ball. In addition to being kinder to your privates, it’s a great all-over core strengthener.

Deep squatting. Deeper than you would squat in an exercise class. This also stretches and tones really well. Check out the Garland yoga pose for perfect form. You can incorporate the deep squat into your post-workout stretching. And Couch potatoes, squat while you are watching TV.

Why the title? After having my second child, I put some serious time into strengthening my netherlands. So, imagine my delight when during a recent GYN exam, my midwife nearly gasped in surprise when she asked me to contract my perineum. “Wow! You could crack a walnut with those muscles!”

And that, my friends, was the nicest compliment I’d gotten in a long time.

In conclusion… trust me when I say, you’ll thank me later, ladies!

You’re Going to Make Me Talk About Childhood Vaccinations, Aren’t You?

Posted: 2123 days ago in Parenting

childhoodvaccinationsSigh.

And I only say that because there are some very strong opinions surrounding this issue, and I’m certain that I will piss someone off. 

Here’s what I know: when a healthy body has appropriate amounts of good quality food, rest, exercise, stress management and a properly functioning nervous system, it has the best opportunity to resist all disease through a strong immune response.  Exposure to disease through contact with a contagious person OR through vaccination in this case will quite likely not result in illness or adverse reaction.

However, an immuno-compromised person is much more likely to catch the disease or have an adverse reaction to a vaccine. One also needs to think about the likelihood of exposure to each disease and the potential severity of each disease, compared to the frequency and number of vaccines recommended over a finite period of time.

I personally do not believe that every child needs every vaccine, especially in multiple doses over a relatively short period of time. There are many parents who choose single doses, spread out over a long period of time, rather than an all-or-nothing approach.

The best approach, in my opinion, is to do your research. Read books in support of and against routine vaccination. Talk to other like-minded parents. Have an honest conversation with your child’s doctor. Listen to your gut. Make an informed decision.

Personally, my choices for my children are not my recommendations for my patients, readers or friends. I am grateful to have two beautifully healthy, unvaccinated girls. None of the decisions regarding their health are made lightly, and we are committed to a lifestyle that supports their health in every controllable way.  I just finished re-reading a fabulous book by Stephanie Cave, MD:  “What Your Doctor May Not Tell You About Children’s Vaccinations”.

Well worth the trip.

The Secret to Making Homemade Baby Food

Posted: 2126 days ago in Parenting

home made baby foodI wasn’t one of those moms who anxiously awaited feeding our girls their first solid foods. Nursing was easy, available, and didn’t require me to wash any more dishes. Waiting until they seemed ready to eat was the approach I took, and they gave me very clear signs that it was time for something more substantial: they shoved food in their mouths.

Francesca face-dove into a burrito I was eating, and Julia shoveled some soup into her mouth.

After that, I kept a few store-bought jars handy, but mostly, I made my own baby food. And by make, I mean that I generally just smashed whatever I was eating with a fork and fed it to them. Occasionally, if it was a bit chunky, I would chew it first, then feed it to them.

(I can hear many of you gagging from here)

It’s really not that gross, and not at all inappropriate. And come on, they had been drinking from breasts that were inside a bra that probably hadn’t been washed in a week (and come to think of it, the breasts probably weren’t either!). Plus, they both passed through my hoo-ha! With their face! Without Purell! So, I figured a little pre-chewed food couldn’t hurt them.

Once babies get the hang of swallowing well, you can move from smooth consistencies to foods with some textures and chunks, and before you know it, they, too, will be shoveling food into their own mouths.

Don’t over-think this one, moms. It’s great to have food grinders, recipes, and packaging systems, if you are looking to buy more stuff and have more chores…

I suggest simply tossing some food, along with a little breast milk, broth, or water into a blender and whirl it up. If you’re making a large batch of something particularly yummy and/or healthy, do that, then freeze it in clean baby food jars. Easy to pop in a diaper bag and hit the road with!

My girls survived my unconventional methods, and I’m proud to say they have hearty, diverse appetites. Luck of the draw? Maybe, but I believe giving your kids a considerable foundation of real food sets them up for success in making great food choices later on.

You’ve Come A Long Weigh, Baby.

Posted: 2147 days ago in Mirror Mirror

longweighbaby2I was a svelte size 16 with a four-month-old hanging off one breast, and a two-year-old crying for lunch when my mother made the mistake of telling me that when she left the hospital a few days after I was born, she wore her size four pencil skirt. However, she was gracious enough to add that she couldn’t button the top button, so she used a safety pin…

I can still see the smug look on her face when she mentioned that. My mom is not at all cruel, but I still hate her a just a little bit for that.

Generally, you can give two women the identical set of circumstances surrounding their pregnancy, a.k.a. the same diet and exercise routines. One, will look like my mom, and the other will look like me.

C’est la vie.

I think that’s why it’s our job as women to:
a.) Not compare ourselves to others, and;
b.) Not let ourselves be defined by a number.

I was so adamant about not being defined that when I would go for my check-ups with my midwife, I would intentionally stand on the scale backwards so I wouldn’t see how much I weighed.

What was I going to do, eat less?!

There’s no perfect number for how much weight you should gain when pregnant. Yes there are averages and guidelines, but I’ve always considered myself to be above average (*wink, wink*). In this case it was probably true.

So, if you eat real foods, in appropriate amounts, and basically eat when you’re truly hungry (and not bored, or sad, or feeling entitled to eat for two), you’ll gain exactly how much you should to have a healthy baby.

This is not rocket science! Give yourself time and be honest with yourself. While pregnant with our girls, I ate really, really well. For dinner I’d have a dark-green salad with salmon, or chicken and tons of veggies. Afterwards, to satisfy my cravings, I would have McDonald’s french fries (with Francesca) and Ben & Jerry’s Phish Food (with Jules) (I’m not really proud of that, but it is what it is!).

Let’s be clear though; it wasn’t a reward. I just ate well, and if I had a craving, I filled it. If you’re someone who wants that sort of thing all the time, then I’d consider whether you’re feeding your mind and not your body.

My message to you ladies – be healthy, and if you are healthy, give yourself a pat on the back. Please also remember that there is just one you, and only you hold the manual to know what that truly looks like.

Natural Childbirth… The Endurance Event With The Coolest Finish Line Gift Ever!

Posted: 2195 days ago in Parenting

Natural Childbirth Disclaimer:  Before you call me out on this, let me say that labor is hard, messy and yes, painful!  But it is not like someone is beating you with a crowbar! Put aside your fear of the unknown, listen to your body and your instincts above what anyone else says, and surrender to the process. You just might find, like I did, a deep understanding and pride that you now know what your body was made for. It’s pretty cool stuff!

Thousands of pregnant women have graced my practice over the last twenty-plus years. Many of them come bearing stories of the CrossFit classes they still proudly participate in, the triathlon they just completed, or for the less sporty crew – the Brazilian they just got and the 4-inch Louboutin’s they squeeze their feet into on a regular basis. What I don’t get is that in the next breath they exclaim how they are requesting an epidural at the first sign of labor. These women put themselves through a lot of pain on a regular basis, voluntarily. And what do they get for it? A cheesy finish line t-shirt and/or bunions. (In the case of the bikini wax…well…).  And yet, at the thought of this very natural, very purposeful pain of labor, they go running for the hills.

Ladies. Please. We were designed to do this, and do it well! When you are allowed to go into labor naturally, and able to move around in order to find comfortable positions – labor is just not that big of a deal. The pain comes and goes as the contractions wax and wane. Each wave brings your baby closer to you and when labor is at its most intense – it’s time to push, and believe it or not, it feels great to get to that point! Your body does an amazing job of producing endorphins (forget the ‘runner’s high’, this is the mother of all highs!), and when it’s all over, you get to look into your baby’s eyes, making all of the pain you just went through pretty much forgotten.