International Cesarean Awareness Network

Education, Support, & Advocacy for Birth Justice & Healing

2015 Accreta Roundtable

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Brandy meets Baby William for the first time, after her surgery.
Brandy meets Baby William for the first time, after her surgery.

 

Welcome to Accreta Roundtable!

Hey folks! This is Lakeisha M. Dennis, Chapter Director and Board Member at Large for ICAN. I am so excited to bring to you the first, I hope of many, roundtables. A roundtable is our way of sharing the latest in news, research and more on a particular topic. For the month of October, we will focus on placenta accreta.

This month, we will bring to you a variety of research articles, events, accreta in the news, as well as personal accounts from those affected by placenta accreta. We will hear from Brandy Firth, chapter leader for ICAN of Hagerstown and Frederick in Maryland, and walk with her through her 2+ year journey with placenta accreta. We will round out the month with a twitter chat and a special contest that you will not want to miss. Be sure to also follow the discussion on our Facebook page as we talk about accreta.

Why are we focusing on accreta? This is our way to honor every woman and family that has experienced placenta accreta (increta, percreta) and to pave a path of support, advocacy and education for the mothers who will invariably face this diagnosis.

Thanks for joining us! Be sure to bookmark this page for daily updates. If you would like to join the conversation, follow along on Facebook, Instagram, Twitter, Pinterest or this blog!

All the best,

L.D.

 

Day 1:     Part One: What is accreta? Accreta defined…

Day 2:     Part Two: Life-Threatening Complication of Prior Cesarean

Day 3:     Part Three: Risks to Mother and Baby

Day 4:     Part Four: Accreta Diagnosis and Treatment

Day 5:     Part Five: Brandy’s Accreta Story

Day 6:

Day 7:

 

[Read more…]

Click Your Way to the Best Info: finding quality VBAC and Cesarean info online

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By Sharon Muza, BS, CD(DONA) BDT(DONA), LCCE, FACCE

While April is recognized as Cesarean Awareness Month in both the United States and many other countries, quality consumer information about how to prevent cesareans (both primary {first} cesareans and subsequent ones) along with information about having a vaginal birth after a cesarean (VBAC) is valuable to families all year long.

Many families scour the internet looking for practical information and best practices, as well as inspirational stories that help them to feel less isolated and alone when they are recovering from a cesarean or planning another birth.

Here are my favorite websites to share with families who have experienced a cesarean or are planning a VBAC. I like these websites because they are easy to read and contain many articles relevant to cesarean and VBAC families. The first seven are great resources for evidenced based information and best practices on the topics of cesareans and VBACs. The last three are simply great inspirational websites where you can find stories of strong people birthing their babies. Everyone needs to celebrate the strength and courage that is demonstrated by birthing families.

best vbac cesarean info online

Evidence Based Birth

EvidenceBasedBirth.com, while only a couple of years old, has quickly proven to be a valuable resource time and time again. Rebecca L. Dekker, PhD, RN, APRN is the author and she has the wonderful ability to evaluate reams and reams of research and boil it down to important information that consumers can use. Many of her articles are available as a PDF to print and bring with you to a doctor or midwife appointment.  Some of my favorite posts that I think are particularly useful to the VBAC family include big babies, rupture of membranes, and due dates.

VBACFacts.com

Jen Kamel is well known nationally for both her website and her VBACFacts.com class. Her slogan – “Don’t Freak. Know the Facts.” She maintains a comprehensive list of posts that explain the research on many of the obstacles that face VBAC families – information on different types of incision repair, VBAC after more than one cesarean, induction for VBAC parents and my favorite among many – “Want a VBAC? Ask Your Care Provider These Questions.”

Well Rounded Mama

Well Rounded Mama, at first glance, seems like a website for plus or larger sized people, but honestly it is a fantastic website for any person who is having a baby, particularly after a cesarean. Pam Vireday does extensive research and her blog posts often cover issues that face many of us as we try and navigate our care after a cesarean. Her motto is “Because mothers and children come in all shapes and sizes. And because people of all sizes deserve compassionate, gentle, helpful care.”  “The Fat Vagina Theory – Soft Tissue Dystocia” is one of my favorite posts, but I look forward to every post that Pam publishes.

About.com Pregnancy & Childbirth

This expansive website is written by Robin Elise Weiss, PhD, author of many pregnancy and childbirth books and current president of Lamaze International. Robin’s blog posts are short and easy to read and full of relevant links where you can get more follow up information. They are always accurate and based on current evidence and chock full of resources and suggestions. I like to search on the topics of VBAC or cesarean to find posts of interest, but really, I enjoy reading everything Robin writes.

Spinning Babies

Gail Tully is the author and creator of SpinningBabies.com and I just love her site. As a midwife, Gail has a unique perspective and I appreciate the breadth of information that packs her site. Since some cesareans are a result of a malpositioned baby, the information found here can help families to progress a labor that may be not moving along due to baby’s position. Additionally, for those facing a cesarean for a breech baby, Gail’s techniques may help to get that baby to turn head down. Lots of pictures and a new look make this site easy to use and refer to, even in labor when ideas and suggestions are especially needed. If you had a cesarean for a malpositioned baby, you will for sure want to be familiar with the information on Spinning Babies as you get ready to birth again.

Midwife Thinking

This blog comes from “down under” and is filled with great information on many topics that apply to cesarean and VBAC families. Midwife Rachel Reed takes on some of the myths that get perpetuated on birth and breaks them down in posts that are well researched and full of current information. Be sure to check out “Amniotic Fluid Volume: Too Much, Too Little or Who Knows?” and “VBAC: Making a Mountain Out of a Molehill” and “In Celebration of the OP Baby,” as well as many others that she has written. I encourage you to check out Rachel’s website and read more of her work.

Giving Birth With Confidence – A Woman’s Guide to VBAC

This consumer friendly website for all pregnant families has a very well written guide for VBAC’ing women, based on the 2010 VBAC Consensus Statement held by the National Institutes of Health. Over 10 different well-written resources make up this comprehensive guide to help people understand the research, make informed decisions and navigate the obstacles that they may face when they are planning to VBAC.

Black Women VBAC

This blog is full of stories of people of color who have had successful VBACs and is a great place for all people who are interested in inspirational birth stories to check out. People of color experience cesareans at a rate that is disproportionate to white people and the impact is significant. Read about the courage and strength that these families demonstrated and get inspired yourself.

About.com VBAC Birth Stories

A comprehensive collection of a wide variety of VBAC stories submitted by readers of About.com.

Plus Size Pregnancy Birth Stories

Collated by the same person who writes “Well Rounded Mama” (see above), this is an extensive collection of VBAC, VBAMC and Cesarean stories that will be sure to provide tons of inspiration and encouragement to families who have experienced a cesarean or are planning to birth after a cesarean. While the site is a wee bit dated, it is an extremely comprehensive collection.

These are some of my favorite websites for consumers to learn more about cesareans, VBACs, the VBAC climate, and what the current research says about both cesarean and VBAC birth. Families today need to be informed and prepared to navigate the choices and options available to them as they prepare to welcome a baby, in hopes of avoiding an unneeded cesarean and birthing after a previous cesarean.

What are your favorite websites, blogs and research sources for finding information on the topics of cesareans and VBACs? Share them with our readers in the comments section as we celebrate Cesarean Awareness Month.

 

About Sharon Muza

Sharon Muza headshotSharon Muza, BS, CD(DONA) BDT(DONA), LCCE, FACCE has been an active childbirth professional since 2004, teaching Lamaze classes, including “VBAC YOUR Way” and providing doula services to many hundreds of couples through her private practice in Seattle, Washington. She is an instructor at the Simkin Center, Bastyr University where she is a birth doula trainer. Sharon is also a trainer with Passion for Birth, a Lamaze-Accredited Childbirth Educator Program. Sharon is a former co-leader of the International Cesarean Awareness Network’s (ICAN) Seattle Chapter, and a former board member of PALS Doulas and Past President of REACHE.  In September 2011, Sharon was admitted as a Fellow to the Academy of Certified Childbirth Educators. Sharon Muza has been the community manager, writer and editor for Science & Sensibility, Lamaze International’s blog for birth professionals, since 2012. Sharon enjoys active online engagement and facilitating discussion around best practice, current research and its practical application to community standards and actions by health care providers, and how that affects families in the childbearing year. Sharon has been a dynamic speaker at international conferences on topics of interest to birth professionals and enjoys collaborating with others to share ideas and information that benefit birth professionals and families. Sharon lives with her family in Seattle, WA. To learn more about Sharon, you are invited to visit her website, SharonMuza.com.

New study shows no difference in neonatal mortality for vaginal delivery of early preterm vertex babies versus cesarean deliveries

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A new study released in ACOG’S reports showed no increased neonatal mortality for vaginally delivered preterm infants who were in the vertex position at the time of delivery. Additionally, 84% of the 79% of women who attempted a vaginal delivery were successful.

The abstract as well as links to the full study are available here: http://www.ajog.org/article/S0002-9378(12)00636-9/abstract

Monthly Research Review

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By Karen Troy

VBACResearchposts@gmail.com

Co-Leader, ICAN of Chicago

Welcome to the first monthly installment of our new blog feature – VBAC Literature Update.  Each month I will provide a list of new peer reviewed literature that has been published with the past 30 days on the topic of VBAC.  I will also provide some commentary on what I believe is important/relevant about each article.  The abstracts to each of these articles, and often the full text, can be accessed at www.pubmed.gov, the National Library of Medicine.

1: Khaskheli M, Baloch S, Baloch AS. Obstetrical trauma to the genital tract

following vaginal delivery. J Coll Physicians Surg Pak. 2012 Feb;22(2):95-7.

PubMed PMID: 22313645.

This article is from a third-tier Pakastani journal, and the findings are not relevant to how medicine is practiced in the United States or other industrialized countries.  For instance, they report a 37% rupture rate in grand multiparas (women with more than 5 children) and a 16% maternal mortality rate.  We can all be thankful that our outcomes are significantly better than this!

2: Teguete I, Maiga AW, Leppert PC. Maternal and neonatal outcomes of grand

multiparas over two decades in Mali. Acta Obstet Gynecol Scand. 2012 Feb 7. doi:

10.1111/j.1600-0412.2012.01372.x. [Epub ahead of print] PubMed PMID: 22313177.

Another study similar to the first, but in Mali.  They found that women with many children tend to have fewer birth complications than women with fewer children, probably because if you weren’t healthy to begin with you wouldn’t be on your 5th, 6th or 7th child!

3: Nooh A. Is it worth inducing labour in women with a previous caesarean

delivery? J Obstet Gynaecol. 2012 Feb;32(2):141-4. PubMed PMID: 22296423.

This is a case series that examines outcomes in women who were planning VBACs and were induced.  The study design is not particularly strong.  The journal is not particularly strong, probably because this is the only place this author could get the research published.  I would not put a lot of weight into the data reported here, but do agree with the author that inductions should involve a shared decision making process between moms and doctors, carefully weighing the pros and cons, especially in a VBAC situation.

4: Benson MD, Cheema N, Kaufman MW, Goldschmidt RA, Beaumont JL. Uterine

Intravascular Fetal Material and Coagulopathy at Peripartum Hysterectomy. Gynecol

Obstet Invest. 2012 Jan 19. [Epub ahead of print] PubMed PMID: 22261240.

This one got pulled because it mentions uterine rupture as a factor in the problem they’re exploring, but it doesn’t have anything to do with VBAC.

5: Barros FC, Matijasevich A, Hallal PC, Horta BL, Barros AJ, Menezes AB, Santos

IS, Gigante DP, Victora CG. Cesarean section and risk of obesity in childhood,

adolescence, and early adulthood: evidence from 3 Brazilian birth cohorts. Am J

Clin Nutr. 2012 Feb;95(2):465-70. Epub 2012 Jan 11. PubMed PMID: 22237058; PubMed

Central PMCID: PMC3260073.

These authors wanted to know whether cesarean birth was associated with long-term obesity rates.  The theory is that because babies born via c-section don’t get inoculated with all of those lovely bacteria on their way out, their guts are not populated in the same way as vaginal birthed babies.  This may influence how people digest food and absorb calories.  Turns out there is not an association with cesarean birth and obesity.  I’m not sure why this came up in my VBAC search.

6: Sun HD, Su WH, Chang WH, Wen L, Huang BS, Wang PH. Rupture of a pregnant

unscarred uterus in an early secondary trimester: A case report and brief review.

J Obstet Gynaecol Res. 2012 Feb;38(2):442-445. doi:

10.1111/j.1447-0756.2011.01723.x. Epub 2012 Jan 10. PubMed PMID: 22229814.

Case report of an unfortunate woman who spontaneously ruptured during pregnancy.  Not relevant to VBAC.

7: Tinelli A, Hurst BS, Hudelist G, Tsin DA, Stark M, Mettler L, Guido M, Malvasi

A. Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and

outcome reports. Hum Reprod. 2012 Feb;27(2):427-35. Epub 2011 Nov 16. PubMed

PMID: 22095838.

This is a series of women who had laparoscopic myomectomy (this is minimally invasive surgery to remove uterine fibroids) and then subsequently got pregnant and gave birth.  In this group most of the women did get pregnant after fibroid surgery and most of them had vaginal births.  32% had cesareans.  When you consider that the national average is 32%, this isn’t too bad.  They do not report any ruptures after myomectomy.  For more information on myomectomy and birth options, please see the special scar website here:  www.specialscars.org

8: Jackson S, Fleege L, Fridman M, Gregory K, Zelop C, Olsen J. Morbidity

following primary cesarean delivery in the Danish National Birth Cohort. Am J

Obstet Gynecol. 2012 Feb;206(2):139.e1-5. Epub 2011 Sep 24. PubMed PMID:

22051815.

This is a retrospective study comparing second pregnancies in a group of 21,500 women who had a vaginal first birth to 3340 women who had cesarean first births (all in Denmark).   Not surprisingly, mothers with prior cesareans had a higher risk of complications with subsequent births.  Nothing particularly new here, though this does add to the data set on this sort of thing.

10: Brailovschi Y, Sheiner E, Wiznitzer A, Shahaf P, Levy A. Risk factors for

intrapartum fetal death and trends over the years. Arch Gynecol Obstet. 2012

Feb;285(2):323-9. Epub 2011 Jul 7. PubMed PMID: 21735187.

This examines risk factors for intrapartum fetal death and concludes that uterine rupture, among other factors, is a risk.  Duh.

11: Ronel D, Wiznitzer A, Sergienko R, Zlotnik A, Sheiner E. Trends, risk factors

and pregnancy outcome in women with uterine rupture. Arch Gynecol Obstet. 2012

Feb;285(2):317-21. Epub 2011 Jul 7. PubMed PMID: 21735183.

This study examined a cohort of 240,189 singleton births occurring between 1988 and 2009.  Of these, rupture occurred in 138 births (0.06%) total, increasing from 0.01% in 1988 to 0.05% in 2009.  Their statistics are presented in a confusing way, but in a nutshell, previous cesarean delivery increases your odds of uterine rupture, not surprisingly.  I was hoping to see something in here that was actually modifiable by either mom or doctor as being significantly different between the rupture and non-rupture group, but this was not the case.  All in all, disappointing as an article.

New Feature on the Blog!

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We are very excited to tell you about a new feature we think you’ll find really useful on the Blog! Karen Troy, Co-Leader of ICAN Chicago, will be guest posting monthly, reporting on the latest published and peer-reviewed literature on VBAC.  She will also be including some of her own commentary on the articles, hopefully sparking some dialogue here and on our Facebook Page!  The first post will be up tomorrow morning, so check back then to read the very first post in this feature!