International Cesarean Awareness Network

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Why I Came to ICAN – A Chapter Leader’s Story

March 1, 2019 by blog

Why I Came to ICAN – A Chapter Leader’s Story

Tamoyia Ragsdale, ICAN of Bowie

Two years ago, while pregnant with my third baby, I had a cesarean due to complete placenta previa, followed by an emergency hysterectomy due to severe hemorrhaging. Most of my days following felt heavy and dark. My therapist suggested that I join a support group for women that have had cesareans, so I googled and the International Cesarean Awareness Network (ICAN) was the first thing that popped up.

I was so excited that I had found a support group, but I was also terrified that it meant that I had to pack up my depression and sadness and physically be present at a meeting. I was afraid to show up in front of people, to be vulnerable and offer my story, to be the inspiration for “The Gasp”—you know the one, when people are so shaken that they gasp in disbelief, their faces marked by sudden sadness. “The Gasp” is a reminder of how much pain I was in. It always happens—when I get to the part where I share that I no longer have my uterus, that darn gasp sucks all the air from the room, like a confirmation that, yup, this is pretty bad.

I’m also a survivor of rape and molestation, so the cesarean trauma went deep. The throwing away of an organ so sacred to me, the bright lights, being strapped down naked on a cold table without anyone asking if it was okay. All of it was so traumatizing that when I laid down to sleep at night, my body felt so heavy. As if I would just sink into the mattress. I was for sure that sadness and grief would suffocate me in my sleep and at that level of emotional pain, I sort of welcomed the thought. My womb was gone!

I was diagnosed with post traumatic stress disorder (PTSD), postpartum anxiety, and depression. I felt as if the woman I once knew had left, as if she died on that operating table and left me with a substitute person or a stand in. I didn’t feel like me anymore. The scar was all that I was left with, all five inches of it. My obstetrician describes it as “pretty unnoticeable,” but for me felt like it stretched across my bikini line for miles.

I felt incomplete, like a home that was never finished being built, or a road that was never fully paved, or a book that someone shelved and just stopped writing.

One day, a friend of mine asked me if I would accompany her to visit an ICAN meeting. In my head I was thinking, “No, way! I’ve been running from that meeting for a year now!” I had been following the local-to-me groups on Facebook for a while at this point, unable to bring myself to a meeting. But now the pressure was on!

So many thoughts ran through my head, but I eventually gave in and agreed to go with them. The day finally came and, as promised, I woke up and began to dress, all the while thinking of all the ways that I could back out of this commitment.

I got in my car and started driving, thinking to myself, “What the heck is wrong with you, turn around now!”

This ICAN meeting in particular was held at a police station, and as a person of color, my original unease doubled. As a black woman, I didn’t feel comfortable there, and I was upset that it wasn’t taken into consideration that a police station wouldn’t feel like a safe space for me and many other people of color.

Nevertheless, I gathered my emotions and went in. Going around the room, everyone introduced themselves and began sharing their experiences after their cesareans. I sat, waiting for my turn and thinking to myself, “This is going to feel like throwing up knives.” My palms were sweating, I felt like I was going to pass out.

And then I heard another woman say exactly what I had been feeling: “I felt so lost after my cesarean.”

It was at that moment that I knew I wasn’t alone. Finally, I wasn’t alone!

But there was still something missing. After attending two meetings, I realized that no one in these groups had looked like me. There were no black women in the room. How is that even possible when black women make up the highest percentage of those who’ve had cesareans?

Black women are affected the most by cesareans and other birth related emergencies, yet we are the least represented in the birth world.

Let that sink in.

Our presence is far and few between in the exact spaces where we should be represented.

As a Black woman, I realize that many women of color will stay away from support if they find that it isn’t facilitated by another woman of color. We need the, “Hey, sis!” greeting, a tight hug from one black woman to another that lasts for minutes—as if she knows you needed it; we need the deep rooted presence of the ancestors sitting amongst us, feeling our pains, mourning with us.

So many of us black women already have broken hearts, so many us feel the pain of our mothers of mothers past—the post-traumatic slave disorder that many of us battle daily on top of our birth trauma. We know that black women die at four times the rate of any other race in childbirth. We get it, and we can connect with one another in the midst of this truth. No explanation is needed.

When I talk about ICAN, people ask me, “What is that?”—for so many, ICAN is an unheard-of resource. But for me, ICAN means so much more because of all of this, all of the things I’ve shared with you here. All of it led me to becoming a chapter leader. I wanted to facilitate a support space for those who have experienced cesarean births, but especially for my people.

I want to hold space for the countless Black Women/Women of Color who are in search of support. I wandered alone for two years feeling misunderstood, and I waited for someone to embrace me and say, “I see you.” And now I want to do that for others like me.

ICAN is such an amazing organization! The resources that are given to women who are feeling lost or that just want more information are beyond words, and I am honored to be a part of the fountain of knowledge and support pouring out into my community. I look forward to facilitating and holding the space for all who need it. This is me, this is my journey!

This post was written by Tamoyia Ragsdale, Chapter Leader Of ICAN of Bowie (Maryland)

Filed Under: ICAN, Support, Testimonials

CBAC Guest Post: Physical Recovery After CBAC

February 27, 2018 by blog 1 Comment

During February 2018, birth stories and articles featured on ICAN’s blog will be focused on CBACs – Cesarean Birth After a Cesarean. It is a term used to describe a birth that was planned as a VBAC, Vaginal Birth After a Cesarean, but instead resulted in another cesarean.


Physical Recovery After CBAC

By Pamela Vireday

Artwork by Molly Remer, from Brigid’s Grove Etsy Shop

Physical Recovery

Having a CBAC is hard. Usually, it involves recovering from both the rigors of labor and major surgery and of course recovery can be harder after multiple cesareans. In addition, CBAC mothers have a higher incidence of complications like infections and bleeding, and about 2% experience significant morbidity.

It is hard to process emotions when your body is struggling to heal. Many women find it is helpful to focus first on physical recovery after a CBAC. Here are some ideas to help promote physical recovery.

  • Rest as much as you can – The most potent tool for physical healing is rest. If you are doing too much, your body must divert energy from its recovery. It can be hard to get enough rest with a new baby, but with the support of others, you can prioritize as much rest as circumstances allow
  • Ask for help – Don’t be afraid to enlist help from friends, family, your partner, or a post-partum doula. Others should be doing the cooking, cleaning, shopping, and caring for other children; your priority is to feed the baby and sleep as much as possible at first
  • Take pain meds when needed – Don’t neglect pain medication post-partum; you’ve had surgery. Take them a little bit early, before the pain gets ahead of you. Taper them off over time, but don’t be afraid to take them for as long as you need them
  • Set up your home to make recovery easier – Have all the supplies you need right at hand, including a water bottle, the phone, extra diapers and burp cloths, healthy snacks, a footstool, and extra pillows to make positioning more comfortable. Include some entertainment for yourself (a book, the TV remote, music) for those moments when baby just won’t let you get up
  • Eat healthily – Your body needs help to repair tissue and replace lost fluids. Get plenty of iron-rich and vitamin C foods and stay well-hydrated to replenish your blood supply. Adequate protein plus vitamins A and E are important in helping to rebuild tissue. Let others feed you, but keep around plenty of easy snack foods like string cheese, nuts, fresh and dried fruit, and pre-sliced vegetables to make grabbing a bite easier while caring for the baby
  • Don’t go back to your regular schedule too quickly – Many women go back to a normal schedule too soon after a baby is born, and their body lets them know it’s too soon with increased bleeding and pain. Respect what your body is telling you. Take it easy for as long as you can once you get home from the hospital
None of these hints is a magic pill that will wipe away all pain and difficulty. You still will have a surgical recovery, with all the pain and fatigue that entails. Although CBACs are usually harder than primary cesareans, not all are hard. Some have an easy recovery. Others have more difficult recoveries, and a few have very complicated recoveries. Let’s talk more about these.

Dealing with Complications

Although major injuries are quite unusual after CBAC, they do sometimes occur. Women who have experienced major physical trauma (like severe bleeding, significant infection, severe scar tissue, surgical injury to nearby organs, uterine rupture, or hysterectomy) will need significant support as they recover.

If you have experienced complications, it is important to take recovery slowly, since setbacks can easily occur. Get as much rest as possible and seek out complementary therapies like acupuncture, chiropractic, Maya Abdominal Massage, physical therapy, or nutritional counseling to help support your recovery.

Bleeding 

One study found that about 35% of CBAC women experienced significant bleeding, while other studies have found much lower rates. Differing thresholds for defining hemorrhage explains many of these differences, but blood loss is a real risk to be aware of.

If you experienced significant bleeding during your labor or cesarean, have your provider check you for anemia. Being anemic can make healing more difficult, impair milk supply, and prolong fatigue, yet many providers are not proactive about monitoring for this. Taking extra iron, eating iron-rich foods, and taking supplements like Floradix can help your iron levels recover. Women with hypothyroidism may have more trouble with anemia and should probably be extra proactive about this and have additional tests.

If you experienced a major hemorrhage, you should be watched for Sheehan’s Syndrome. This is when part of the pituitary gland dies due to a relative lack of blood supply to the area if a hemorrhage happens during childbirth. This can impact milk supply negatively and eventually lead to secondary thyroid dysfunction and many other distressing symptoms. Sheehan’s Syndrome often doesn’t present fully until years later, sometimes not fully triggered until a successive health crisis (surgery, infection) causes an adrenal crisis. If you experienced a major hemorrhage during your birth, be aware of the symptoms of Sheehan’s Syndrome and be ready to advocate for testing if needed.

Infection

Women who have a cesarean after a VBAC trial of labor have increased rates of infectious morbidity. One study found that 25% of CBAC women experienced chorioamnionitis afterward, although other studies have found lower rates.

If you experienced a major infection after your CBAC, this can involve a long hard healing process. If you are still in the hospital (or are readmitted later), ask about IV antibiotics instead of oral ones, and ask for a consult with a wound or infection specialist.

Some women have had better healing on an infected cesarean wound using a wound vacuum (Negative Pressure Wound Therapy, NPWT), while others have found it painful and not very useful. Basically, it sucks out fluids and infection and draws more blood to the area to improve healing. Bandages are changed about 3x/week, which some women find quite painful; be sure to take your pain meds at least an hour ahead of time. Some people report that using alcohol between the skin and the bandage ahead of time can help remove adhesive tape more easily, and infusing saline first into the sponge inside the wound can ease its removal considerably.

Medical-grade honey is another option (FDA-approved) that has shown some promise in limited studies. It is rarely utilized for cesarean wound issues in first-world countries but can be another option to consider if you do not want the wound vacuum or find it too painful. You might have to strongly advocate for it since it is used more often in non-obstetric wounds and most OBs won’t be familiar with it.

If you are heavy, ask about using weight-based dosing for your antibiotics. Not all antibiotics need weight-based dosing but many do, yet the research shows that the majority of doctors tend to under-dose patients of size, especially those with a very high BMI. Research also shows that “obese” people benefit significantly from longer courses of antibiotics, IV antibiotics instead of just oral ones, and more frequent dosing regimens, so ask your care provider to consider these options too.

Scar Tissue and Nerve Damage

Some women develop significant internal scar tissue (adhesions); the more cesareans you have, the more at risk for adhesions you are. One study found that 46% of women with three or more cesareans had developed “dense” adhesions. These types of adhesions can lead to significant pelvic pain, difficult menstruation, and even bowel obstructions.

Severe cases of adhesions may require additional surgery to break them up. Although this has the risk of creating more adhesions, some women find significant relief with it. Other women are able to address pelvic pain from adhesions through physical therapy, massage, yoga, acupuncture, and Maya Abdominal Massage techniques, which can help loosen and break up the scar tissue.

Some women experience long-term numbness after their cesarean from nerve damage. Although this has little medical significance, it can have significant emotional significance to the woman involved, who may mourn the loss of sensation in the area. Sometimes an “itching” feeling can be felt from the inside, even though scratching on the outside does not help. The loss of sensation in the area around the scar is often cited by cesarean mothers as one of the more distressing results of their cesareans. Again, the techniques above may help loosen scar tissue and restore some degree of nerve function.

Injuries to Nearby Organs

Because the uterus is located in the abdomen, one of the risks of surgical birth is injury to nearby organs like the bladder and bowels. This is not a big risk, but if it happens to you it is a big deal.

One study found an incidence of 0.86% of bladder injuries in women who had a CBAC after a trial of labor. Although this risk is low, it does increase in the face of prior cesareans, especially if dense adhesions are present. It is also increased in the face of induction and augmentation.

Sometimes these injuries occur for other reasons. One CSAC mother I know shares her story of recovery after a severe surgical injury by a doctor who was angry with her for laboring “so long”:

My bladder was severely damaged through a surgical error during my CSAC. The surgical error was made in an O.R. environment of carelessness and anger that I had fought against CSAC and labored for so long (~60 hours).

Things that helped me recover were: Time, innate stubbornness, acupuncture to help my bladder relearn how to contract after surgical reconstruction, EMDR therapy for PTSD, and antidepressants. My recovery was long and so hard and 7 years later I can finally see the progress I’ve made.

Uterine Rupture

Uterine rupture is rare but it does happen occasionally. When it happens, it can be absolutely devastating, emotionally and physically. Although usually, the rupture is able to be dealt with in a way that preserves both the uterus and the baby, in worst case scenarios the uterus, the baby, or both may be lost. The mother can be left with tremendous physical and emotional trauma.

Obviously, the mother will need to watch for many of the complications listed above. Sheehan’s syndrome, in particular, should be monitored for. Once the initial healing is over, the mother may feel better physically with some of the complementary therapies listed above.

There are groups that specialize in support for women who have had a uterine rupture. You can find more information about these groups here and here. Please also look into the resource groups listed below that help women deal with birth trauma.

Hysterectomy

Women who have a CBAC are at increased risk for hysterectomy, although the absolute risk for this is also low. In one study, about 1% of CBAC women had a hysterectomy during labor.

Of course, if you are among that 1%, it feels like a very personal risk. To lose your uterus and all future childbearing potential is a tremendous grief. Even though the hysterectomy may have been necessary, it still can be traumatic to recover from physically. Hormonal changes due to the hysterectomy may intensify both the physical and emotional recovery. Find a sympathetic care provider to help ease you through these changes. A naturopath or a doctor with a more “alternative” mindset may be your best bet. Acupuncture may also help ease these changes.

Unfortunately, there are not a lot of resources available specifically for women who experience hysterectomy after a trial of labor. There are groups that offer support after hysterectomies in general; these groups can be found here and here. If you search on these sites for “hysterectomy during childbirth” you will find other women who have had similar experiences. Here is a link to an article on coping with unexpected hysterectomies.

Women who lose their uterus during childbirth may develop symptoms of Post-Traumatic Stress Disorder (PTSD). There are a number of organizations out there who can help women dealing with PTSD after childbirth, including Solace for Mothers and others listed below.

Conclusion

The good news is that research shows that the rate of significant complications after a CBAC is quite low. Medically speaking, most CBAC mothers will experience a pretty unremarkable recovery.

However, recovering from a cesarean is always a challenge, especially when you already have older children to take care of. Many mothers try to do too much too soon and end up delaying their recovery and exhausting themselves. It’s important to remember that you’ve had major surgery and to let others take care of you as much as possible.

If you experienced a complication after a CBAC, that can make your recovery, both physical and emotional, harder. Even more difficult are the rare but very serious complications like injuries to adjacent organs, uterine rupture, or hysterectomy. If this has happened to you, please be sure to get extra support for your physical healing and personal support for your emotional healing.

Although most women benefit from focusing first on their immediate physical recovery, sometimes the emotions of a CBAC are so overwhelming that they need to be addressed right away in conjunction with the physical healing.

If you feel overwhelmed emotionally, find a way to debrief the birth as soon as you can. This can be with your providers (if they are supportive), with a doula, with a birth-friendly therapist, or with your partner. The important thing is to find someone who is truly supportive and emotionally safe to speak to, not someone who will downplay your emotions or tell you to “just get over it.”

Finding a support group of like-minded women who have been through a similar experience is also vital in dealing with birth trauma. See the resources below for links to birth trauma resources and support groups.

Resources

Emotional Support for CBAC Mothers: 

  • http://cbac-support.weebly.com/
  • https://www.facebook.com/groups/cbacsupportgroup/
  • http://community.babycenter.com/groups/a6703205/cbac_mamas
  • https://groups.yahoo.com/neo/groups/CBACsupport/info

Emotional Support After a Difficult Birth: 

  • www.solaceformothers.org
  • www.birthtraumaassociation.org.uk
  • www.ptsdafterchildbirth.org
  • http://health.groups.yahoo.com/group/ptsdafterchildbirth/
References 


*Note: The medical community uses the term “failed” in the following abstracts. Do not let their terminology bring you down. We are NOT failures and we did not fail. 

Scifres CM, Rohn A, Odibo A, Stamilio D, Macones GA. Predicting significant maternal morbidity in women attempting vaginal birth after cesarean section.Am J Perinatol 2011 Mar;28(3):181-6. PMID: 20842616

…We set out to identify factors that are predictive of major morbidity in women who attempt VBAC. A nested case-control study was performed within a large retrospective cohort study of women with a history of at least one cesarean. Women who attempted VBAC were identified and those who experienced at least one complication of a composite adverse outcome consisting of uterine rupture, bladder injury, and bowel injury (cases) were compared with those who did not experience one of these adverse outcomes (controls)…Of 25,005 women with a history of previous cesarean, 13,706 (54.9%) attempted VBAC. The composite outcome occurred in 300 (2.1%) women attempting VBAC. Using logistic regression analysis, prior abdominal surgery (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.2 to 2.1), augmented labor (OR 1.78, 95% CI 1.29 to 2.46), and induction of labor (OR 2.03, 95% CI 1.48 to 2.76) were associated with an increased risk of the composite outcome. Prior vaginal delivery (OR 0.39, 95% CI 0.29 to 0.54) was associated with decreased risk for the composite outcome…Women attempting VBAC with a history of abdominal surgery or those who undergo augmentation or induction of labor are at an increased risk for major maternal morbidity, and women with a prior vaginal delivery have a decreased risk of major morbidity. The multivariable model developed cannot accurately predict major maternal morbidity.

Obstet Gynecol. 2006 Jul;108(1):21-6. Maternal complications associated with multiple cesarean deliveries. Nisenblat V1, Barak S, Griness OB, Degani S, Ohel G, Gonen R. PMID: 16816051

…The records of women who underwent two or more planned cesarean deliveries between 2000 and 2005 were reviewed. We compared maternal complications occurring in 277 women after three or more cesarean deliveries (multiple-cesarean group) with those occurring in 491 women after second cesarean delivery (second-cesarean group). RESULTS: Excessive blood loss (7.9% versus 3.3%; P < .005), difficult delivery of the neonate (5.1% versus 0.2%; P < .001), and dense adhesions (46.1% versus 25.6%; P < .001) were significantly more common in the multiple-cesarean group. Placenta accreta (1.4%) and hysterectomy (1.1%) were more common, but not significantly so, in the multiple-cesarean group. The proportion of women having any major complication was higher in the multiple-cesarean group, 8.7% versus 4.3% (P = .013), and increased with the delivery index number: 4.3%, 7.5%, and 12.5% for second, third, and fourth or more cesarean delivery, respectively (P for trend = .004). CONCLUSION: Multiple cesarean deliveries are associated with more difficult surgery and increased blood loss compared with a second planned cesarean delivery. The risk of major complications increases with cesarean delivery number.

Am J Obstet Gynecol. 2007 Jun;196(6):583.e1-5; discussion 583.e5. Perinatal outcomes after successful and failed trials of labor after cesarean delivery. El-Sayed YY1, Watkins MM, Fix M, Druzin ML, Pullen KM, Caughey AB. PMID: 17547905

…Matched maternal and neonatal data from 1993-1999 in women with singleton term pregnancies with prior cesarean undergoing trial of labor were reviewed. Women with uterine rupture were excluded. Maternal and neonatal outcomes were analyzed for successful and failed trials. Predictors of success and failure were examined. RESULTS: 1284 women and their neonates were available for analysis. 1094 (85.2%) had a vaginal birth and 190 (14.8%) underwent repeat cesarean. Failed trials of labor were associated with higher incidence of choriamnionitis (25.8% vs. 5.5%, P<.001), postpartum hemorrhage (35.8% vs. 15.8%, P<.001), hysterectomy (1% vs. 0%, P=.022), neonatal jaundice (17.4% vs.10.2%, P=.004) and composite major neonatal morbidities (6.3% vs. 2.8%, P=.014). CONCLUSION: Failed trial of labor in women at term with prior cesarean is associated with increased maternal and neonatal morbidities.


Permission to repost given by Pamela Vireday. Read more on her blog.

Filed Under: CBAC, Support Tags: CBAC, Support

CBAC Guest Post: Cesarean Birth After Cesarean, 18 Years Later

February 22, 2018 by blog

During February 2018, birth stories and articles featured on ICAN’s blog will be focused on CBACs – Cesarean Birth After a Cesarean. It is a term used to describe a birth that was planned as a VBAC, Vaginal Birth After a Cesarean, but instead resulted in another cesarean.


Cesarean Birth After Cesarean, 18 Years Later

By Pamela Vireday

Image from Wikimedia Commons, here

My CBAC Story

Eighteen years ago, my second child was born. He was born by repeat cesarean after a long, hard “trial of labor” which included 5 hours of pushing with no progress because he was big and posterior with an upright (“military”) head position.

I’ve second-guessed that birth for many years. It’s possible that if we’d pushed even longer, his head would have molded enough to fit through my pelvis and turn anterior on the perineum, as many posterior babies do. However, at that point, I was absolutely exhausted, in a lot of pain, and was worried about the wisdom of continuing when things had gone so long without progress. I knew a non-progressing labor was a risk factor for rupture, plus my baby had experienced some issues with his heart rate. They resolved, but I didn’t want to go into a repeat cesarean in true emergency mode because of a rupture or fetal distress, and emotionally I needed to make sure that I didn’t have an anesthesia failure like I did with my first cesarean.

At that point, I just had a strong sense of Inner Knowing that it was time to be prudent and stop before things became a real emergency. I believe I made the right decision, but it was hard to communicate that to my husband and support team. My doula treated me like I had wimped out and thrown in the towel too easily. I never heard from her again after the cesarean. It was clear she viewed me as a failure.

I dreaded having to go back to my VBAC groups and tell them I’d had a CBAC, but I gritted my teeth and did it anyway. I got some sympathetic responses, but mostly I got a lot of silence or tepid responses that felt judgmental. No one knew how to reply to someone who hadn’t gotten their VBAC.

Over the years, there was a lot of armchair quarterbacking about my decisions. People meant well, but I was left feeling pretty unsupported. And I didn’t feel I could really emotionally process the birth fully in birth spaces because I was afraid of discouraging new mothers or those planning their VBACs. No one wants to hear about when VBAC doesn’t work out.

Eventually, I was able to access some resources that helped me emotionally process my first two births. It took a lot of hard, emotionally grueling work, but in time I came to peace with those births, and I did have two VBACs afterward.

In some ways, the CBAC was healing from my highly traumatic first cesarean, but in other ways, it would always remain hard, even though I felt like it was a prudent and wise call under the circumstances. My consolation was my precious child, but his birth would always remain bittersweet to me in some ways, especially because of the initial lack of support. And that led me to try to improve support for other women who had difficult or traumatic births, especially CBAC mothers.

Expanding CBAC Support

If about 75% of labors after cesarean end up with a VBAC, that means that about 25% of these labors end with another cesarean. Where is the support for women who have an undesired second cesarean? Where is the acknowledgment of all the work they put in towards a VBAC, the hours of labor, the pain, the worry? Does all that preparation and work not count if you don’t end up with a VBAC?

In time, I began to realize there was a vacuum of support for the mothers who didn’t VBAC. It wasn’t just about my own experience anymore, but also about other moms. How could we make it so that all mothers felt supported, regardless of outcome? Shouldn’t we offer emotional support after any cesarean, whether it’s your first or another one?

I wasn’t the only one, of course. A number of us shared this experience of another unwanted cesarean, including people in the leadership of ICAN, and we began to talk about how to offer better support. One of the first things we did was ditch the terms used in the medical literature, terms like “Failed VBAC” or “Failed Trial of Labor After Cesarean.” We felt this was too judgmental and insensitive. We were not “failures,” we did not fail, and we should not have been on trial.

We created the term Cesarean Birth After Cesarean(CBAC) as a more mother-friendly alternative. It refers to a cesarean that occurs when the mother really wanted and worked for a VBAC but didn’t get one. These women had different emotional needs than those who wanted a repeat cesarean, and terminology needed to reflect that difference. So we used “CBAC” to differentiate another unwanted cesarean from Elective Repeat Cesarean Section (ERCS), where women truly wanted another cesarean and voluntarily chose it. Neither one is good or bad; they are simply different experiences.

There are many shades of CBAC. Most of the time, it refers to someone who labored and ended with another cesarean, but it can also refer to a cesarean performed before labor for medical reasons, because the mother had no choice, or because the mother was coerced or scared into a repeat cesarean. Some women prefer “CSAC” (Cesarean Surgery After Cesarean) because they consider the term “birth” too emotionally loaded. Women get to choose the term that seems right for their own experience. The important thing is to acknowledge and validate the range of feelings that women have over this experience.

Of course, all CBAC mothers are not alike. Having the shared experience of a CBAC doesn’t mean other details of our situations are similar. Each CBAC is unique, and each carries its own particular color and resonance of pain.

Some had disappointing or traumatic experiences, and some didn’t. Some felt very betrayed by their caregivers, while others had very supportive caregivers. Some felt they had a “prudent CBAC,” where although it was difficult, a repeat cesarean felt like the right choice under the circumstances. Some had an “empowered CBAC,” where even though there were disappointment and sadness, there was powerful learning and healing too.

Some CBAC mothers go on to have a VBAC eventually, while others never do. Some have multiple CBACs, each with their own emotional resonance. Some have a VBAC and then a CBAC, which has its own particular pain. A few have had the bitter experience of having lasting physical and emotional damage from their CBAC, including uterine rupture, hysterectomy, and damage to or loss of their baby. As always, each person’s experience is different and unique, and each CBAC mother needs safe space to process all the varying feelings about those experiences. But this can be difficult to do within regular birth forums.

Some people don’t think there needs to be any separate support for CBAC mothers (“a cesarean is a cesarean”), and to this day, many of us with CBACs still have our decisions questioned and second-guessed in birth forums. Although many doubters have come around to offer more support, CBAC still remains a topic of friction at times within the birth community. This needs to change.

New CBAC Resources

Over the years, we have tried to expand resources for CBAC mothers. We have offered several CBAC sessions at ICAN conferences and at local chapter meetings, and until recently we had a Yahoo group for online support.

In 2011, I offered a CBAC workshop at the St. Louis ICAN conference. The session was derived from discussions by mothers on the Yahoo CBAC Support Group, and many graciously consented to share their thoughts and quotes to help others. At that session, we brainstormed ways to offer further support for CBAC moms.

One of the main ideas was to have an online website devoted to CBAC support and information. So Melek Speros, Catherine Kowalik Harper, and I created a CBAC Support website, based on my material from the 2011 workshop and suggestions I got there. On this site, we share CBAC research, websites where CBAC moms can go for emotional healing, information on the unique emotional needs of CBAC mothers, suggestions for processing a CBAC, CBAC birth stories, inspirational quotes for healing, and suggestions for birth professionals to help them better support CBAC mothers.

ICAN has also created a new online support group via a Facebook page for CBAC mothers. This is a closed group; you have to be a CBAC mother to join. It offers intensive, personal support for those dealing with the aftermath of a CBAC.

ICAN is also about to publish a brand-new brochure on CBAC. It is intended for ICAN leaders and other birth professionals who may encounter a woman who has recently had a CBAC and is in need of extra support. We encourage birth professionals to include this brochure in a resource packet that they can send to women shortly after a CBAC so these mothers realize that they are not alone, that others have walked the CBAC trail and survived, and that there are resources for further support if they want it.

In future years, I hope we can create even more ways to help support CBAC mothers. If you have other suggestions for how we can do that, please add them in the comments section.

Final Thoughts

Eighteen years after my own CBAC, it remains a potent memory. My sweet little boy is a strong and independent man now, flying off on new adventures, but his birth is still a touchstone for many different emotions. Although I did eventually go on to have 2 VBACs after the CBAC, those experiences didn’t “fix” the CBAC or make it go away. They simply are different entities – not better or worse, just different. Although there are things I still mourn about my CBAC, I have learned to honor all my birth experiences, difficult or easy, because they are a big part of the person I am today.

The lessons I learned from my CBAC remain powerful and still resonate in my life. My CBAC helped me to be more compassionate about other people’s births, to recognize that sometimes there are just things that are beyond our control in the moment. It helped me to realize that sometimes birth is more about the willingness to heal and change; that birth is more about the journey and less about the destination.

In time I learned to honor both the disappointment and the joy in all my births, to remember that what counts most is the parenting we do throughout life rather than how we birth, but also that how we feel about our births counts, even years later. Our deep love for our children is a different and separate thing from our emotions about their births, and while these things intertwine, one does not take away from the other. We can honor the disappointment and mourn the difficulty of a birth while still celebrating and fiercely loving the child that came from that birth.

I found that out of my suffering came the ability to transform pain into advocacy. I found my voice in a new and potent way, and I have endeavored to channel the power of that voice to create change, as well as to create and hold safe space for other women and their unique experiences.

A CBAC is never an easy thing. The pain and disappointment of it stay with you forever, but like other grief, it does ease some and you find a way to live with it, just as you find a way to live with other disappointments in your life. You can celebrate certain aspects of it, you can mourn parts of it, you can still be upset that it occurred, but you honor what it has brought to your life, both difficult and wonderful.

You also learn that in time, out of the pain and conflicting emotions that accompany a difficult experience, there can also come great growth and power to create change for yourself and others. Just give yourself the gift of time and space for that healing. It will come.

 


Permission to repost given by Pamela Vireday. Read more on her blog.

 

Filed Under: Birth Story, CBAC, Support Tags: Birth Story, CBAC, Support

CBAC Guest Post: Supporting Women When VBAC Doesn’t Happen – Part Three: Supporting the Mothers

February 20, 2018 by blog Leave a Comment

During February 2018, birth stories and articles featured on ICAN’s blog will be focused on CBACs – Cesarean Birth After a Cesarean. It is a term used to describe a birth that was planned as a VBAC, Vaginal Birth After a Cesarean, but instead resulted in another cesarean.


By Pamela Vireday

“Remember, no effort that we make to attain something beautiful is ever lost.” – Helen Keller

In the first post of our series – Supporting Women When a VBAC Doesn’t Happen – Part One: A Unique Grief, we discussed how women who want and work for a VBAC but end up with a cesarean have a unique grief that is different from a primary cesarean or an elective repeat cesarean. Many women who have experienced a CBAC say they felt unsupported and isolated. They had nowhere to tell their stories, nowhere to process their anger and got little sympathy from those around them.

In the second post – Supporting Women When a VBAC Doesn’t Happen – Part Two: The Forgotten Mothers, we examined what research there is on CBAC mothers and found limited wisdom to guide us. In the absence of research on how best to help CBAC mothers, we must rely on the words and experiences of CBAC mothers to tell us what they need.

In the final part of our series today, we suggest concrete ways that birth professionals can support CBAC mothers, based on suggestions made by CBAC mothers themselves. Keep in mind that each story and woman is unique, and the needs of one may be different than the needs of another. The best thing to do is to follow the lead of the CBAC mother; she will tell you in word and deed how best to support her.

Create a Safe Space for the Birth Story

One of the most important things that birth professionals can do to help CBAC mothers is to give them a safe space to tell their stories ― their full stories.

CBAC mothers often edit their stories for others, leaving out their disappointment or scary details because people only want to hear the happy parts. When they try to tell the full story, they may hear, “Just get over it already” or “Oh, we’re not going to talk about that again, are we?” CBAC mothers also often self-edit their stories in order not to discourage or scare other expectant mothers. But an untold story is one that weighs heavy on the heart.

Be the safe person to whom the full birth story can be told. Be truly present while listening. Don’t armchair-quarterback her story; suspend your judgment, put aside your own birth agendas, and focus only on supporting this woman, right now, in this situation. Eliminate distractions, use attentive body language, and really focus on the woman so that she truly feels like she is being heard.

Realize that she may need to tell the story multiple times; each time she tells it, she processes it on a new and different level. Ask her, “What do you need from me right now?” so she can tell you if she wants something more than just listening. If possible, check in with the woman’s partner, who may also need help processing or understanding why the mother is still coming to terms with her experience.

“Listen. Listen. And don’t contradict. Just listen. Don’t compare. Just listen. And don’t try to make me feel better. Just listen.” – Kristina R.

Use Creative Support Techniques

Once the mother is ready to start processing the birth story further, use reflective listening techniques. Listen to what she says, seek to understand what seems most important to her, and paraphrase back to see if you understood her point. Don’t make assumptions about how she is feeling or add judgments. Ask open-ended follow-up questions that invite her to explore her feelings if she is ready. Give her the time and space to come to her own conclusions about her experience.

Many women find that journaling, making art, singing, writing poetry, and participating in rituals is helpful in processing their emotions. This can be particularly helpful for those who get stuck in a negative feedback loop or who need to process significant trauma. Don’t be afraid to refer to a good birth-supportive therapist in your area if needed.

Validate the Mother

CBAC mothers need to have their experiences and feelings validated. Mothers need to be reminded that their hard work and accomplishments during birth are still valid, however, the baby was born. Acknowledge the amazing sacrifice she made in giving up her own dreams and bodily integrity for her baby.

“CBAC women need validation. They need encouragement that every birth can be different. Above all, they need to be appreciated for the work they did both before and during the experience, the sacrifices made for their babies, and the special place inside themselves that now carries yet another scar.” – Teresa Stire

“Effort does not always equal outcome. Give yourself credit for that effort, and don’t boil it all down to the moment of birth alone.” -Melek Speros

Encourage Bonding

Bonding can be especially difficult after a physically or emotionally traumatic birth. Others may have stepped in to care for their babies, which can leave some mothers feeling incompetent or disconnected.

Start by encouraging more time with the baby. Promote as much skin-to-skin contact as possible; this helps produce more oxytocin and may help breastfeeding too. Some women find bathing or napping with babies to be very healing.

It can be helpful to compartmentalize grief behind an emotional door so women can focus on their baby’s immediate needs, on their older children, and on their own physical needs. However, it’s important that women schedule time periodically to take out the grief, actively work through it, and then put it away. Otherwise, grief may intrude on the bonding process.

Give the Mother Support Resources

Create a CBAC Resource Packet that you can email or hand out as needed. Include a list of CBAC support sites, CBAC brochures, and names of local postpartum doulas or birth therapists. Edit it to each woman’s unique situation.

The International Cesarean Awareness Network (ICAN) has a new brochure about CBAC, which will be available soon in its store, as well as a website dedicated specifically to CBAC, including an archive of CBAC stories. In addition, there is a closed ICAN support group on Facebook just for CBAC mothers.

Although not all CBAC mothers experience post-traumatic stress symptoms, having birth trauma resources in the CBAC Resource Packet puts the ball in the mother’s court and lets her decide the emotional ramifications of her experience. It also gives her concrete options for reaching out for further support, possibly even long after your working relationship with her is over.

Help Her Connect with Other CBAC Mothers

CBAC moms are their own best mentors. This may be the only place CBAC women find others who truly “get” what they are going through.

The unique feelings around CBACs may mean that birth groups, especially those centering on VBACs, could be uncomfortable for a while. Many CBAC mothers feel intensely jealous when hearing other women’s easy birth stories. They may need to insulate themselves for a bit. Taking a break from birth-related groups for a while can be healthy and self-protective; she can return when she is ready.

Of course, not every support resource is perfect. Encourage CBAC mothers to be careful about whom they seek support from. Many well-meaning people say hurtful things like, “Just be grateful you got a healthy baby,” or “You’re just lucky you didn’t die!” CBAC mothers need to find support that will not inadvertently trigger or hurt them more.

Acknowledge Unique Circumstances

Each CBAC is unique, and each may carry its own particular color of pain.

Some women had CBACs because their providers suddenly withdrew support for VBAC at the end of pregnancy or during labor. Some faced so many interventions and conditions during their labors that a CBAC seemed almost inevitable. Some experienced mistreatment and abuse during their experience.

On the other hand, some women had very supportive providers but still ended with a CBAC. Others felt they had a “prudent CBAC,” a difficult but sensible choice because of fetal distress, poor fetal position, rising blood pressure, or other complications. Some had an “empowered CBAC,” where there were powerful learning and healing to help balance the disappointment.

Some women have multiple CBACs, each with their own emotional resonance. Some have a VBAC and then a CBAC, which has its own particular pain. A few have had the bitter experience of having lasting physical and emotional damage from their CBAC, including uterine rupture, hysterectomy, or loss of their baby.

As always, each person’s experience is different, and each CBAC mother needs their unique experiences honored.

“Try on” a CBAC

“Trying on” a CBAC can help birth professionals have a deeper empathy for the unique grief of a CBAC mother.

Consider what it might feel like to have a CBAC. Let yourself feel what it might be like to hope and dream for a VBAC and then not have one, to have to tell everyone afterwards that you didn’t VBAC after all, to listen to the naysayers who believe your body really is broken and who tell you that you should have just scheduled a cesarean section, to listen to other women’s easy birth stories and feel envious all the time.

Walking in someone else’s shoes for a while gives people a better appreciation for the difficulties and the bittersweet feelings surrounding disappointing life events. More empathy for CBAC mothers is definitely needed in the birth community.

Contact the Mother Periodically to Check-In

CBAC is a bit of an emotional rollercoaster and feelings will change over time. The way the mother feels immediately after a CBAC will probably not be the same as a few months or a year later. Check in with her periodically to see how she is feeling about everything and whether there is any way you can support her further. This is especially important for CBAC mothers who have experienced a major trauma.

It’s not unusual for CBAC mothers to experience emotional upset around the six-month mark, on the child’s first birthday, or even later. A quick check-in can affirm that someone remembers and cares about what she is going through.

Discuss Future Pregnancies

Another common point of emotional crisis for CBAC mothers is when the mother considers having another child. At that time she revisits her fear and trauma from past births, decides whether to have more children and if so, may be torn over whether to choose a repeat cesarean or another VBAC trial of labor (TOL).

Although conventional medical wisdom holds that once a woman has had a CBAC, she has shown she cannot birth vaginally, the reality is that a number of CBAC women go on to have a VBAC in future pregnancies, and the American College of Obstetricians and Gynecologists (ACOG) is supportive of VBAC after two cesareans. Women who choose a TOL in this situation may need particularly strong emotional support as they work through their fears and concerns from both a primary cesarean and a CBAC.

However, it’s also important to remember that sometimes a VBAC is truly medically contraindicated, the woman is done having children, or does not wish another TOL. Although VBAC is no longer an option, that doesn’t mean these women are at peace with past or future CBACs. They may still need support too. Little research has been done on how to support this group as they integrate their experiences into their lives. In particular, information is needed on how to support women who experienced significant emotional trauma during birth (Beck and Watson, 2010).

Believe That Healing Can Be Had

Life gives us all disappointments and sometimes these remain bittersweet forever. As with other griefs, you never truly “heal” from a CBAC; the disappointment and loss of that birth are always there, and it never goes away. However, birth professionals need to communicate that – with time and distance – women often come to some sort of peace with the experience.

If given the chance to process their feelings thoroughly, women eventually have enough distance from it to not grieve as sharply, to find lessons or growth in the experience, and to be able to integrate the disappointment of it into their lives.

Some transform the power of the CBAC experience into advocacy, becoming healthcare workers themselves or advocates in birth-related fields. Others practice micro-advocacy by informally helping birthing women they encounter in their personal lives.

Women don’t have to ever be grateful for their CBACs, but in time they can recognize that good things can spring from difficult things, and that great trauma can lead to great growth. The process is not quick or facile, but it can happen. And birth professionals can be a vitally important part of that process.

“My joy [in my births] has gradually returned. I am learning now to honor my experiences…We are not failures, we are no less brave than the women who accomplish the VBAC goal. I keep reminding myself that I will never climb Mount Everest, either, and will probably not accomplish some of the other things I think I want in my life. Maybe this missed childbirth opportunity is just that ─ another missed opportunity ─ and maybe we can find some other accomplishments/ life experiences to compensate. Maybe.” -K

“Today, 12.5 years after my first CBAC, I can honestly say how much growing and learning came from it and for that I am grateful.” -Teresa Stire

“My CBAC made me the compassionate advocate I am today.” -Melek Speros

Resources for CBAC Mothers

Here are a few select resources that may be helpful to CBAC mothers. If you know of more, please add them in the comments section.

CBAC Resources

  • http://cbac-support.weebly.com/ – ICAN’s CBAC website
  • https://www.ican-online.org/product/when-vbac-doesnt-happen/ – link to ICAN’s new CBAC brochure (for new CBAC moms)

CBAC Support Groups

  • https://www.facebook.com/groups/cbacsupportgroup/ – ICAN CBAC Support Group
  • https://www.facebook.com/groups/111066659056348/ – Unplanned CBAC and Birth Trauma Facebook Support Group

General Birth Trauma Support Organizations

  • solaceformothers.org – support for women with traumatic births
  • tabs.org.nz – Trauma and Birth Stress
  • birthtraumaassociation.org.uk – Birth Trauma Association, U.K.
  • ptsdafterchildbirth.org – info on PTSD after childbirth
  • pattch.org – Prevention and Treatment of Traumatic Childbirth
  • http://improvingbirth.org/trauma-toolkit/ – Improving Birth Trauma Toolkit

Articles on CBAC Recovery

  • http://matterhatter.com.au/7-ways-to-cope-with-the-first-year-after-cbac/
  • http://taprootdoula.com/2015/09/15/your-birth-wasnt-perfect-but-you-are-a-perfect-mother/
  • https://www.ican-online.org/blog/2015/11/theres-no-such-thing-as-a-failed-vbac-a-letter-to-the-cbac-mom/

Birth Trauma Articles

  • http://www.uppitysciencechick.com/making_peace.pdf
  • http://www.postpartumprogress.com/birth-trauma-coping-with-triggers
  • http://matterhatter.com.au/birth-trauma-explained-for-fathers/
  • http://www.bellybelly.com.au/post-natal/is-a-healthy-baby-all-that-matters-during-childbirth/
  • http://www.theunnecesarean.com/blog/2011/2/27/comforting-a-woman-traumatized-by-her-birth-experience.html
  • http://www.exposingthesilenceproject.com/gallery.html

Books

  • Rebounding From Childbirth by Lynn Madsen, 1994
  • Ended Beginnings: Healing Childbearing Losses by Claudia Panuthos and Catherine Romeo, 1984
  • Cesarean Voices– ICAN, 2007

References

Beck CT, Watson S. Subsequent childbirth after a previous traumatic birth. Nurs Res 2010 Jul-Aug;59(4):241-9. PMID: 20585221


Permission to repost given by Pamela Vireday. Read more on her blog.

Filed Under: CBAC, Support Tags: CBAC, Support

CBAC Guest Post: Supporting Women When a VBAC Doesn’t Happen – Part Two: The Forgotten Mothers

February 13, 2018 by blog Leave a Comment

During February 2018, birth stories and articles featured on ICAN’s blog will be focused on CBACs – Cesarean Birth After a Cesarean. It is a term used to describe a birth that was planned as a VBAC, Vaginal Birth After a Cesarean, but instead resulted in another cesarean.


By Pamela Vireday

“CBAC mothers have powerful lessons to teach if you are willing and able to hear us.”— Melek Speros

In Part One of the series – Supporting Women When a VBAC Doesn’t Happen – Part One: A Unique Grief, we discussed how women who work for a VBAC but end up with a cesarean have a unique grief that is different from that of a mother who has a primary cesarean or who chooses to have a repeat cesarean.

There is a pressing need for better support for CBAC mothers, but often birth professionals and family members have no idea how to go about offering this support. Does research have any insight on improving CBAC support to these women?

CBAC Research

Unfortunately, there has been very little research done on CBACs. Most VBAC-related research deals with VBAC rates, complications, cost-effectiveness, or the woman’s decision-making process. Women who choose VBAC but don’t end up with one are largely ignored in academic studies.

However, there are a few studies with implications for the CBAC mother, including those that address physical recovery and a few that address emotional recovery.

Physical Recovery

Most CBAC research focuses on physical morbidity, which can certainly have an influence on how a woman feels after a CBAC.

Although most CBAC mothers recover just fine, women who have a trial of labor cesarean do have higher rates of infectious morbidity, postpartum hemorrhage, hysterectomy, blood transfusions, and neonatal morbidities (El-Sayed 2007, Hibbard 2001, Durnwald and Mercer 2004).

One study found that 2.1% of women with a trial of labor experienced major maternal morbidity (Scifres 2011). How much more complicated is the emotional recovery if the mother is also dealing with the aftermath of a serious infection, a sick baby, surgical injuries to nearby organs, anemia from a major hemorrhage, or heaven forbid, a uterine rupture, hysterectomy, or stillbirth?

The lesson here is that some mothers will be dealing not only with the disappointment of CBAC but also with significant physical fallout afterward. This can greatly complicate emotional processing, but sadly, these are often the mothers who receive the least emotional support afterward. It’s as if their complications have made them toxic to the birth community because their experiences represent the rare worst-case scenarios no one wants to acknowledge.

The first step in helping a CBAC mother is to help her focus on her physical recovery, especially if there have been complications, even as you help her explore her emotions around the CBAC.

Emotional Recovery

There is only a small amount of research available on the emotional impact of CBACs. How do women feel about the CBAC experience? Do they regret having tried for a VBAC? Would they want to try again? What can be done to help women process the experience emotionally?

One study surveyed CBAC mothers.(Chigbu 2007) Not surprisingly, they found CBAC mothers, particularly those with no previous vaginal birth experience, often had feelings of:

  • Dashed expectations
  • Inadequacy as a mother
  • Frustration of experiencing the pain of both labor and surgery

Some women experience long-lasting trauma from birth. Although many people have written about Post-Traumatic Stress in childbirth, it is unclear from the research what the most effective approach is for dealing with PTSD in birth.

Some research indicates that Eye Movement Desensitization and Reprocessing treatment(EMDR) can be helpful (Sandström 2008, Stramrood 2012). However, research trials have been extremely small and limited in the childbirth field.

A recent Cochrane review (Bastos, 2015) concluded that there was little high-quality evidence for or against using debriefing interventions to prevent psychological trauma after childbirth. Still, many women find counseling helpful after a traumatic birth, and EMDR helpful if flashbacks are frequent or intrusive.

From anecdotal evidence, anger is a common theme among some CBAC mothers. They may be furious with care providers who let them down, with the seemingly random nature of birth fortunes, or with their bodies for “not working right”:

It was very important to me that someone recognize and validate my anger. I was SO FREAKING ANGRY!!!!! And I needed to hear, “You have every right to your anger!” – Jer

This kind of anger is uncomfortable for birth professionals to hear. We want women to have happy endings and just be enthralled with their babies. But denying anger doesn’t make it go away; it just makes it burrow down more destructively. Helping a mother speak her anger without taking it personally vents it and takes away some of its toxicity so that healing can start to take place.

Many CBAC mothers deal with a strong sense of shame and failure, of feeling broken. Health care providers make this worse when they blame women by telling them their pelvises are “too narrow,” their cervix is “horrible,” or that they have “too much soft tissue” around their vaginas. Health care providers must be careful in issuing judgments such as these because many women told these things have gone on to have vaginal births. More often it’s a case of “this baby, this birth, this time” didn’t work, not that the woman’s body is defective.

Some CBAC mothers obsess over the “what-ifs” of birth decisions or spend a lot of time analyzing what went wrong. This can be a way of asserting a sense of control over what feels uncontrollable. Analysis can sometimes be useful, but it also can lead to a never-ending rabbit hole of self-blame. Sometimes we just don’t know why birth turns out the way it does, and it can help when health care providers and birth professionals share this.

“Pregnancy/childbirth is one of the most unfair endeavors I’ve encountered. Realizing that has set me free in a way. If something as commonplace as childbirth has so many variations even despite what is actively chosen/done, then how can anything else in our lives go the way we want if we just. work. hard. enough. Life isn’t fair. Childbirth, the ease for some, the struggle for others, just isn’t fair. And that’s been liberating for me.” – L

Common Recovery Arcs

Recovery from a CBAC can be an emotional roller-coaster. Many women experience ambivalent feelings and these feelings can change considerably over time.

Immediately after a CBAC, some women are so traumatized that they need to process it immediately. Yet the people around them may feel threatened by any negative feelings around the birth; they don’t understand that women can love their babies but still feel upset about how the baby arrived.

Some CBAC women find a place of temporary peace about the experience. They may be reconciled to its necessity, or may simply need to focus first on the baby and put aside any other feelings. It may only be later that more ambivalent feelings rise up and must be dealt with.

Sometimes right after the birth, women wish they had just chosen a planned repeat cesarean. However, with time, this feeling changes for many CBAC women. One study found that, while women were disappointed at not having a VBAC, 92% of CBAC women “were pleased that they had attempted a vaginal birth” (Cleary-Goldman, 2005). The authors concluded that “Although the most satisfied patients were those who succeeded at vaginal birth, most women valued the opportunity to attempt a vaginal birth regardless of outcome.”

This result was also found by Phillips (2009). Indeed, Chigbu (2007) noted, “This survey revealed that most women still would prefer to be delivered vaginally after 2 previous cesarean deliveries.”

What few surveys have been done show the emotional impact a CBAC can have, but the topic is glaringly understudied. More research is urgently needed on the experiences of CBAC mothers and what can be done to help support them.

In the absence of research to guide us, we must trust what CBAC women tell us they need. More on that in Part Three of the series on Thursday.

References

Bastos MH, Furuta M, Small R, McKenzie-McHarg K, Bick D. Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database Syst Rev. 2015 Apr 10;4:CD007194. doi: 10.1002/14651858.CD007194.pub2. PMID: 25858181

Chigbu CO, Enwereji JO, Ikeme AC. Women’s experiences following failed vaginal birth after cesarean delivery. Int J Gynaecol Obstet 2007 Nov;99(2):113-6. PMID: 17662288

Cleary-Goldman J, Cornelisse K, Simpson LL, Robinson JN. Previous cesarean delivery: understanding and satisfaction with mode of delivery in a subsequent pregnancy in patients participating in a formal vaginal birth after cesarean counseling program. Am J Perinatol. 2005 May;22(4):217-21. PMID:15906216

Durnwald C and Mercer B. Vaginal birth after Cesarean delivery: predicting success, risks of failure. J Matern Fetal Neonatal Med 2004 Jun;15(6):388-93. PMID:15280110

El-Sayed YY, Watkins MM, Fix M, Druzin ML, Pullen KKM, Caughey AB. Perinatal outcomes after successful and failed trials of labor after cesarean delivery. American Journal of Obstetrics and Gynecology 2007 Jun;196(6):583.e1-5; discussion 583.e5. PMID: 17547905

Hibbard JU, Ismail MA, Wang Y, Te C, Karrison T, Ismail MA. Failed vaginal birth after a cesarean section: how risky is it? I. Maternal morbidity. American Journal of Obstetrics and Gynecology. 2001 Jun;184(7):1365-71; discussion 1371-3. PMID: 11408854.

Phillips E, McGrath P, Vaughan G. ‘I wanted desperately to have a natural birth’: Mothers’ insights on Vaginal Birth After Caesarean (VBAC). Contemporary Nurse 2009 Dec-2010 Jan:34(1):77-84. PMID: 20230174

Sandström M, Wiberg B, Wikman M, Willman AK, Högberg U. A pilot study of eye movement desensitisation and reprocessing treatment (EMDR) for post-traumatic stress after childbirth. Midwifery. 2008 Mar;24(1):62-73. Epub 2007 Jan 12. PMID: 17223232

Scifres CM, Rohn A, Odibo A, Stamilio D, Macones GA. Predicting significant maternal morbidity in women attempting vaginal birth after cesarean section. Am J Perinatol 2011 Mar;28(3):181-6. PMID: 20842616

Stramrood CA, van der Velde J, Doornbos B, Marieke Paarlberg K, Weijmar Schultz WC, van Pampus MG. The patient observer: eye movement desensitization and reprocessing for the treatment of posttraumaticstress following childbirth. Birth. 2012 Mar;39(1):70-6. doi: 10.1111/j.1523-536X.2011.00517.x. Epub 2011 Dec 19. PMID: 22369608


Permission to repost given by Pamela Vireday. Read more on her blog.

Filed Under: CBAC, Support Tags: CBAC, Support

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