VBAC INFO

We believe that women should be able to reclaim their bodies and their birthing rights after they have had a cesarean delivery. Due to the great emotional and physical trauma which often occurs and is associated with a cesarean delivery, women opting for a VBAC may need minimal to substantial support from the birthing team. With extra labor support, it has been shown that a majority of women who have had previous cesarean deliveries are able to birth their babies vaginally, with safe and healthy (not to mention emotionally healing) outcomes for both the mother and baby.

We assist with natural, holistic childbirth at home.

We are available and with the laboring mother from the beginning of labor to several hours after the baby is born. This allows continuous care, careful monitoring of both the mother and the unborn baby, emotional and physical support for both her and her partner (who often times can be more nervous than the mother and may have unresolved feelings left from the previous cesarean experience resulting in an unempowered-helpless-fearful emotional state of being). We work with the mother and baby as whole beings, and not just a uterus giving birth to a fetus. We offer natural means of assisting labor. These may include upright walking, position changes, water laboring in warm tub or shower, adequate nutritional and hydration, massage, encouragement, various relaxation techniques.

Babies born vaginally are usually born when they are ready, rather than prematurely by surgery.

Studies have shown that the babies are the initiators of labor by releasing hormones (such as a small amount of oxytocin) to the mother's blood stream which then sets off her own hormonal release, which initiates and continues labor. Although science has does not completely understand this process yet, one theory has been that the baby induces labor when the mother's body is unable to satisfy his-her nutritional needs any longer. In other words, they become hungry and are looking for nutrition beyond the capabilities of the mother's blood-nutrient levels.

On the average, babies born by cesarean and induction have lower birth weights and have fewer weeks gestation than are babies born vaginally without induction. This suggests that cesareans and inductions are occurring before the mother's body is ready (ripe) and the baby has reached full maturity. At the other end of the spectrum, inductions and cesareans occur when the physician fears the baby may be post dates and becoming too large (greater than 4000 g or 8 lbs 13 oz). Determination of baby size is very inaccurate whether by ultrasound or by palpation by an inexperienced health care provider. The babies that have been born by cesarean or induced without initiation of labor account for the majority of admissions to high-risk nurseries. Although some of these infants were born by cesarean or induced because of medical emergencies that may threaten the life of the infant or the mother, a majority of them are miscalculated due dates, fear of large baby size, convenience scheduling, or misdiagnosed fetal-maternal distress.

We do not induce labors using pitocin or PGE2.

Pitocin and prostaglandin (PGE2) inductions are shown to contribute to severely painful labor conditions, higher incidence of fetal distress and injury, uterine rupture and repeat cesarean deliveries. Although these induction drugs have a higher incidence of complications, all of these conditions can also occur without induction and outside of a medical facility, but much, much less often.

When a woman reaches her 42nd week of gestation and she has not began labor yet, some of the holistic (home remedies) which may be used by the woman and her midwife include:

Sexual Intercourse & Orgasm	They cause the uterus to contract and oxytocin to be released in the blood stream (Pitocin is a synthetic version of oxytocin). Orgasm may be with a partner or with self-pleasuring (masturbation) by the pregnant woman herself. Orgasm causes waves of contractions throughout the uterus, stimulating hormone production and contractions. In addition, semen is a rich source of prostaglandins (the principle ingredient in the PGE2 gel used in hospitals to induce labor). It has even been suggested during a midwife's discussion group that oral intake of semen is highly effective in assimilation of the prostaglandins (not to mention that it helps to relax a nervous partner!) and may actually work faster than the cervical application of semen. I personally cannot vouch for the oral connection... but it never hurts to give it a try if you are postdates.
Nipple Stimulation	Whether in love play or a hospital room, the gentle stimulation of one or both nipples also releases oxytocin, helping labor to either start or keep going. Some suggestions have been to have the mother stimulate her own breasts or have her partner stimulate the nipple by hand or by oral (sucking). If an breastfeeding infant is available, having a baby nurse at the breast is helpful. I have even heard of midwives, themselves, stimulating the mothers breasts... but some women and midwives may find this encounter a bit uncomfortable (intimately speaking). In one study, 84% of VBAC mothers who tried this technique managed to get their labors started with nipple stimulation.
Herbs	Although there is little public research available on the use of herbs for labor, many midwives report that evening primrose oil, black or blue cohosh, ginger root, birthroot and red raspberry leaves brewed as tea are sometimes effective in either getting labor started or keeping it going.
Homeopathy	Among the most popular homeopathic remedies for late or slow labor are caulophyllum (or blue cohosh), cimicifuga, and pulsatilla. If you want to try these remedies, talk with a homeopathic physician or get a copy of Homeopathic Medicine for Pregnancy and Childbirth, by R. Moskowitz(North Atlantic Books, Berkley CA, 1992)
Castor Oil	Made from the bean of the castor plant, castor oil has a laxative effect, much like an enema. If the cervix is ripe already, castor oil can stimulate contractions. It apparently works best with women having their first labors. The usual dose is 2 ounces, and it ordinarily takes effect in two to six hours. Some midwives recommend an "induction mix" or a "labor cocktail" of 2 ounces each castor oil, orange juice, and vodka (vodka optional). The best time to swallow castor oil is very early in the morning, so that you're not kept up all night with diarrhea (it will definitely clean out the colon, which can be beneficial with women having constipation problems that may inhibit the baby's head from engaging well in the pelvis or slow labor progression because of a full colon).

We do not use pain medications during labor.

Labor drugs (epidurals and other medications are often used in medical settings. In the United States, more than 90% of women in some hospitals use the epidural anesthesia. When done correctly, some women have found this method to be an excellent pain relief, especially for the exhausted laboring woman.

However, No drug administered during labor has been found to be totally safe for the baby. ALL drugs cross pass the placental barrier to the baby during labor. There are potential side effects for the mother and the baby.

The most common effects of an epidural on a baby during labor is a fluctuating heart rate. Labor drugs, in general, can have greater potential for fetal distress, resulting in hypoxia (low oxygen), possible brain damage and fetal death. After birth, a depressed respiratory system and other neonatal complications are common. Apgar scores generally are lower in medically managed births with a higher incidence of babies being placed in neonatal intensive care units.

Maternal complications can include a drop in maternal blood pressure. Women having medications are usually confined to their beds during labor, attached to electronic fetal monitors (EFMs) and a IV drip. This can make labors longer. Another effect that an epidural can have in a first-time labor -- which is what the woman may be having if she did not have a previous vaginal birth, is a slowed or stopped labor. If an epidural is performed early in labor at 2 centimeter dilation, there is a 50% chance of another cesarean. At 3 centimeters, there is a 33% chance, and at 5 centimeters dilation, an epidural will put you at little or no chance of a cesarean. Some women develop fevers 100.4 or greater after having epidurals. This can effect their babies. About one-third of babies born to feverish mothers are taken to NICU for further testing for sepsis (infection), sometime with very painful test procedures such as a spinal tap (lumbar puncture in which spinal fluid is drawn out for testing). Women having epidurals often time have problems with second stage labor and have difficulty in pushing out their babies. Episiotomies are common place and always used with forceps or vacuum extraction usage for these medicated births. Both of these can be traumatic for the baby and can result in serious injury.

10 Moons Rising Midwifery Services will accept healthy, low-risk VBACs as clients for a homebirth setting as long as they fit within our standard of care. We hope to provide an alternative service to VBAC moms not wanting a standard hospital birth with a high possibility of a repeat cesarean.