For a quick peek without the commentary, scroll down to the Table below. 

As it seems half of my clients over the next 6 mos are hopeful VBAC mamas, I am constantly reminded that we have to keep these intervention conversations going not just for them but for our first time moms! Let's please get the word out however we can - PREVENT the PRIMARY CESAREAN! You can do this by informing yourself and other pregnant women of these common maternity practices in the US and how they can change a labor, birth, baby, and woman. The biggie - unnecessary inductions. A woman is not OVERdue just because she has passed her due date. Post term pregnancy begins after the 42nd week, and induction is NOT supported before that date, especially for first time moms, because of the risk of cesarean. Spontaneous labor is your friend! A friend worth the wait! 

Below is a table created by Rebecca Dekker from Evidence Based Birth. Citations are available by visiting her post which she also shared on Improving Birth.Org : 
http://www.improvingbirth.org/2012/11/state-of-maternity-care/

I 



Encourage anyone hoping to avoid a cesarean birth to choose their birth location and provider CAREFULLY and hire a doula! It's great to take an out of hospital childbirth prep class, too, but going into the hospital with professional labor support is invaluable in helping women avoid routine interventions that lead to cesarean birth without improving mom and baby safety, according to evidence. So many women don't know! Believe me, I hear the stories from moms during their second pregnancies all the time at consultations. There are way too many women who just don't ever come across this info and don't know what to expect at the hospital during labor and how it can affect their birth, baby, and future! They trust their doctors and that the hospitals wouldn't do anything unnecessary or that could possibly be risky. And while those of us immersed in helping to change things don't believe that many care providers are ill-intentioned, we do know this - standard and routine practices being used in hospital labor and delivery care are not supported by evidence, not even recommended by ACOG! And yet they are still used on women everyday and leading to UNNECESSARY CESAREANS. Take a look at the chart - for you, your sisters, your friends, your daughters. And while you may be uncomfortable offering unsolicited advice, how would you feel wondering if you had gently passed on this information and it having prevented a woman and baby you love from unnecessary harm. 

I know we all find ourselves asking...but why? Why do hospitals practice this way? Why would our OB's do these things if not based in evidence? If not backed by their own professional organization? I think the simple answer is that this is just how they are trained.  "Managing" every step of the labor process is how they've experienced birth in the hospital setting. Ultimately, it's easier to manage a bunch of women's labors using these routine practices coupled with it being more in their comfort zone. Taking spontaneous labor off the table in the majority of their patients really puts a lot more control in their hands, too, which I believe is a good match for most of their personalities ;) ...and schedules, dare I say. That is, of course, all my opinion. Not based on evidence. ;) 

And for local information and support for managing interventions in a "trial of labor after a cesarean" (TOLAC) as a hopeful VBAC mom, please attend the ICAN meeting this Saturday at 10 am at Ohm Chiropractic in Media. It will be a roundtable discussion featuring tips from local doulas, ICAN leaders, and experienced moms! https://www.facebook.com/events/598029813590109/

Our son joyously arrived at 10:08pm on Monday, April 29th.  He came on his due date, which happily is the first of my expectations he decided not to fulfill.  I had told people for months that we would have a May baby, but he had other ideas.  My husband and I were lounging on the couch in the afternoon of the 28th when I felt a sudden desire to rush to the bathroom.  I knew immediately that my water had broken and remembered to note the color, smell, etc. like Lori had told us.  Water continued to seep from me for the next eight hours or so, in varying amounts.  The amount of water surprised me!  Good thing I had a bag of sanitary napkins on hand.  

Dan (the husband, not the baby!) and I frantically packed our bags and called The Birth Center in Wilmington, which is where we were planning on giving birth.  Because I am Group B Strep positive, the midwife (Durenda) requested we come in and start an antibiotic.  I felt high and expectant on the ride to Delaware.  I had not had any contractions yet.   When we arrived  Durenda confirmed that I had experienced premature rupture of membranes (PROM).  I was about 2cm dilated and 60% or so effaced. She suggested that we take a walk and get something to eat at a local restaurant, which we did feeling anxious and gleeful.  After dinner, we considered getting a hotel, which would have meant that we would have to come back to TBC every four hours during the night so the antibiotic could be readministered.  Durenda suggested we sleep there, saving us the hassle.  Very nice!  

During dinner and the walk, I had several slight contractions that felt more like the Braxton-Hicks  variety with little pain.  Things were going slowly so we were reminded that if active labor had not begun within 24 hours of PROM we would be transferred to Christiana Hospital. After we returned to TBC, Durenda suggested taking some homeopathic tablets to help speed the process of labor.  She also presented castor oil as an alternative.  After consulting with Lori, I decided to try to castor oil immediately and try the homeopathy in the morning if it was needed. In hindsight, I should have done everything suggested immediately, but at the time I wanted to sleep a little and thought contractions would begin very soon.  I slept on my left side that night with my belly hanging over the edge of the bed to try to help Baby Danny position himself in the ideal position, with the knowledge that he had been on my right side for the majority of my pregnancy.  The castor oil did not kick in until early the next morning, and I had mild contractions through the night and was able to sleep pretty well.  

The next morning, midwife Sarah gave me the homeopathic herbs and Lori arrived with breakfast foods from Wawa. I was still only about 3 cm dilated and a little more effaced, but satisfactory progress wasn't being made.  I started to feel slightly desperate with the thought that we would be transferred, so after some more castor oil I tried nipple stimulation in the shower, which brought some better contractions.  After about thirty minutes in the shower, we tried taking a walk and doing some pelvis-opening stretches, but another exam revealed that I still wasn't 4cm dilated, which had been our indication that active labor had begun.  Sarah told me that we would need to be transferred, which was heartbreaking to me because I saw a C-section at the end of the ordeal.  I had a good cry, then we packed up and went to the hospital.   

As soon as we arrived, my contractions became more painful.  I was incredibly frustrated with the paperwork in triage, including seemingly irrelevant questions like the name of the county in which I was born.  Apparently, my husband, who took over after I showed clear frustration with the questioning, was also asked three times, "Are you sure she has no Spanish heritage?"  Not sure why this was of interest to them.  Finally, Sarah spoke up and asked if I could go to our room and we were told we could. We arrived in the room about 2:00pm.  As soon as we arrived an IV was started and I was given Pitocin to induce more contractions. The nurses were kind to all of us; I didn't feel any animosity about our wanting to do things as naturally as possible.  The nurses even seemed to respect Sarah and Lori's perspective and knowledge. I think they would agree.   

I found not being able to walk, squat, or move in general very difficult.  I turned to my left and waited between contractions. I experienced very little sensation in the front of my body, but the pain in my back was sharp.  Luckily, Dan never left my side and massaged both sides of my spine during each contraction.  Lori or Sarah stayed in front of my face, while the other stroked my leg or applied pressure on pressure points to help the contractions speed along.  

A habit I developed that Lori later said was unique: during contractions I sang or repeated phrases.  In the beginning, I said things like: "OPEN" in a firm, calm voice; "somos juntos" ("we are together"), a phrase that resonates with me after a trip to Mexico a couple of years ago; "ganbare!" ("go for it!" in Japanese); "there is no bliss like this" (a favorite affirmation from yoga practice); and simply "YES!"  I also told myself to be calm and that what I was feeling was a pain that creates, not that destroys.  As the contractions increased in duration and frequency, I sang long high notes or scales and didn't repeat phrases.   Lori told me I also sang "Somewhere Over the Rainbow." I could not have made it through without this comfort measure, which made me feel powerful and as though I was still in control of something.  At one point, the nurses explained that they were concerned about the baby's heart beat, so they wanted to use an internal monitor.  This device sticks into the baby's head using a piece of wire that looks like a screw.  Lori and Sarah said it was a good idea, and with the idea that a healthy baby was the goal I agreed.  

Around 9:00pm someone asked if I was feeling pressure in my bowel, which I said was true. The pressure increased with each contraction, and Lori was coaching me not to push but to use puff breaths during each contraction to avoid the urge.  During the puff breaths, I began to push uncontrollably.  The pushing felt like a sort of muscle reaction that I could not control, similar to what I imagine a seizure might feel like.  Someone (a doctor?  I never saw her again) said that I was fully effaced and dilated, so everyone agreed with smiles that I could start pushing.  A bar was used across the bed for me to put my feet on and the OBGYN on call arrived.  He said the pushing was going very quickly.  I commented to Lori and Sarah that this part was very satisfying and almost pleasurable because it was empowering to feel I was getting things accomplished.  Several other nurses joined us and everyone was shouting "Go, Sara! Push!" which really helped me stay motivated.  The hospital nurses commented that it was unusual for me to be smiling and seemingly enjoying myself. I think around this time I said to Lori, "I am a warrior" and she heartily agreed with an encouraging smile.  

I expected to be shocked by my baby, so had done a lot of visualizing during pregnancy of the moment when he emerged.  There was no shock involved, he felt like mine and someone I already knew. I don't think the visualizations had anything to do with this feeling; I just think it was the first hormonal reaction of motherhood to know that this creature is mine and no one else's, not even my husband's in the same way as he is mine.  

The placenta came away quickly, though I think the doctor had something to do with that as his arm was somewhere inside me just before it emerged.  The stitching process was not pleasant; I had a third degree tear because our baby was on the larger side (9lbs, 14 ounces) and came out with his arm wrapped around his head. I am disappointed with doctor's performance; he was by far the least caring member of the team and did nothing to keep me informed of what he was doing.  He almost seemed annoyed by my questions.  Our baby spent the next 3 and a half days in the NICU, which is another long story!  If anyone is interested I'd be happy to share.  The end result of all of this is currently asleep on my lap.    :)

Last thing for all you first timers who might come across this: a short list of recommendations.
1.  Hire a doula.  I VERY HIGHLY recommend Lori.  If possible, also have another support person plus your partner for a total of three.  I know that these people's presence there meant that the interventions were kept to an absolute minimum.
2.  Pack a bag in advance and pack as though you'll be gone for several days.  Better to have to much than too little.
3.  Get in shape NOW.  Even if you're already pregnant, find something to do that will keep you fit.
4. I hate to say this, but expect to be disappointed in the doctors you meet.  Find others to trust.   

THE END! Ah, but also a huge beginning for our family!