C-Section Rates at ‘"Epidemic" Levels

The current trend of "unnecessary surgeries is jeopardizing women’s health," the U.N. World Health Organization warned in a report published in the medical journal The Lancet.

"Unnecessary C-sections are costlier than natural births and raise the risk of complications for the mother, said the report surveying nine Asian nations. It noted C-sections have reached “epidemic proportions” in many countries worldwide."

Read the full Associated Press story: http://www.msnbc.msn.com/id/34826186/ns/health-pregnancy/

Supporting Mothers Choosing VBAC

Yesterday I attended a workshop concerning the particular needs of moms who are attempting vaginal birth after cesarean. Most doctors won't even attempt a VBAC and some midwives won't either. But besides finding a care provider who will be supportive of her decision, a mother choosing VBAC will need distinctive care.

Jessica Atkins taught the workshop at Centre Vida, a birth center in south Austin. There were 12 doulas in attendance.

As I am at almost every workshop I attend, I was reminded that the role of a doula is not to fix things or to make lots of suggestions or to use the newest techniques I've learned, but to listen and to support the mother as best I can. That support will look different based on the client, so it is important that I am listening to her and learning to recognize her needs.

This is a great piece that Jessica shared with the attendees:

Support Is...

Unconditional.

Listening.

Not judging and telling your own story.

Not offering advice.

Offering a handkerchief, a touch, a hug… caring.

We are here to help women discover what they are feeling…

not to make the feelings go away.

We are here to help a woman identify her options…

not to tell her which options to choose.

We are here to discuss steps with a woman…

not to take the steps for her.

We are here to help a woman discover her own strength…

not to rescue her and leave her still vulnerable.

We are here to help a woman discover that she can help herself…

not to take that responsibility for her.

We are here to help a woman learn to choose…

not to make unnecessary for her to make difficult decisions.

The workshop didn't cover any specific comfort measures for women experiencing VBAC, but it did provide me with lots of interesting statistics about the cesarean rate in the USA today compared with decades past and other countries. Having that information and understanding more about the risks of cesarean birth will be helpful in understanding the concerns of women who are wrestling with whether or not to choose VBAC.

What is a doula?

Experiencing a Spiritual Cesarean

Tonight I attended a two-hour workshop led by Lanell Coultas on the topic of c-sections. She is an excellent teacher and she could really teach a 6-week course on this topic. But we didn't have that much time, so we spent most of the session role-playing and walking through what the mom and dad and baby might encounter during a c-section and how the doula could best support them.

A few people shared stories and Lanell offered suggestions. More than any of her suggestions, though, I am always most impressed by how Lanell remains so calm and sensitive and genuine. She empathizes so deeply and seems to get to the root of issues in a way that makes me want to sit at her feet and soak up all of her knowledge and wonderfulness. :)

So, don't get caught up in the to do's or not to do's and definitely don't take them as rules, but consider some of these ideas that Lanell offered:

- Don't avoid talking about cesarean birth with your client. Sometimes doulas and other fans of natural birth methods act like they might jinx a birth by even mentioning a c-section. But by neglecting to talk about the possibility or to consider how you might respond in such a situation, you do your client a great disservice. It is a good idea to let her know that a c-section is always a (distant) possibility and it might be a good idea to bring a CD to listen to in the operating room or comfy socks, in the event that she has to walk from L&D to the operating room. It doesn't mean she needs to spend time worrying about a c-section. But she can be a little more prepared, just in case.

- If your client is having a planned cesarean, encourage her and her partner to establish a common vision that they can reflect on during the moments throughout the birth when they are separated. This might include when the mom is getting her spinal anesthesia or when the dad goes to the nursery with the baby. If the mom and dad are sharing a common thought about their home or their baby or their dreams, they can feel connected despite the temporary physical separation. This is also a great way to help them go inward, and not get distracted by all the noise and hustle and bustle of the operating room.

- When the anesthesiologist gives the mom the bolus, she might shiver or shake quite a bit. You can support her by gently and firmly holding the pressure points in the arches of her feet. This can help her to feel grounded and should help relieve a little bit of the shaking.

- Slow down. Help the mom to focus on her vision, her dream, and not get flustered by all of the adrenaline in the room.

- If she is concerned about the c-section being anti-climactic compared to labor and vaginal delivery, give the mom some ways to experience this as a rite of passage. She can go inward and speak the words her baby needs to hear. She can imagine the surgery that is happening and how her baby is emerging into the world. She can focus on the doctor's hands and pray for him. Lanell told about a client who was meditating to focus all of her love for her baby into the doctor's hands so that the baby could feel his mother's love that first moment when the doctor touched him.

- Suggest that the dad take lots of pictures so that the mother can fill in all the blanks in her birthing experience. He can ask the anesthesiologist to take some pictures of the surgery and of the new family, too. :)

- Tissues with a few drops of essential oils are a good idea for both the dad and the doula. The scent of peppermint or lavender can remind you to slow down and experience the moment and can also combat the unpleasant smell as the doctor cauterizes the mother during surgery.

- Affirm the mother in her pain. Not having seen the procedure, the mother may feel guilty for not being more resilient or for needing pain medication. Remind her that she has just undergone major abdominal surgery and her body has lots of recovering to do. It's okay to use pain medication if she needs it.

In light of my recent thoughts about supporting dads, I also thought Lanell had some particularly good ideas about the dad's role in all of this. She said the dad can assume that his place is always with the baby. If he ever needs to step back, a doctor or nurse will tell him. But he can know that he has a clear and significant role as he accompanies the baby while the mother is stitched up and goes to recovery. Also, it is completely natural that he wants to protect his child and reunite his family. It's okay for him to be like a broken record, asking if he and the baby can see mom yet... When they are all together again, he can tell her about the surgery and about everything that happened in the nursey. His words will contribute significantly to how the mother processes the whole experience.


Anyway, there was so much more, but I don't want to get caught up in little details. Basically, Lanell challenged us to think about the fact that once c-sections become necessary, they really are just that - necessary. Whether it's because of the mother's feelings, the father's thoughts, the doctor's experience, circumstances beyond anyone's control, or whatever, once they have decided on a c-section, it is necessary. Because at that moment, it's the best way. She compared it to this vortex that everything is flying around in, to bring about this one result.
And in the end, a baby will be born. and it is still amazing!