ARTICLE
FOR 2005 FALL ISSUE
San Diego Conference on Cesarean and
VBAC – A Summary
By: Claudia E. Villeneuve
 Cesarean
avoidance and the promotion of VBAC, vaginal birth after
cesarean, are extremely important topics to any pregnant
mother, especially around the issue of maternal choice
. Since I find these topics fascinating imagine my surprise
when I discovered there are conferences dedicated to them.
The International Cesarean Awareness Network (ICAN), The
California Association of Midwives and the Birth Resource
Network, joined efforts for the first time to organize
the “Reclaiming Our Choices in Childbirth” conference from
April 29 to May 1 st , 2005 in sunny San Diego , California
. One look at the list of speakers and presentation topics,
and I couldn't book my flight fast enough. The next ICAN
conference is in 2007. This is a summary of the lectures
I attended over the three days:
“Transforming Birth: Becoming a
Mother-Friendly Hospital ”, Tanja Johnson
Staff at a hospital in Three Rivers , Oregon
, worked very hard to re-accept VBAC patients after the Administration
had decided to ban it for medical, economic and legal reasons.
This presentation will be useful for birth advocates in the
Edmonton area to convince Capital Health to re-consider the
October 2003 ban at the Stony Plain hospital (Shared Care
Program at the Westview Health Centre) and re-accept VBAC.
“Vaginal Birth After Multiple Cesareans:
Keeping the Dream Alive”, Pamela Vireday
Slide after slide of statistics, medical
research references, and personal stories of why women with
multiple cesareans can still dream of having a vaginal birth
and have an almost 75% achievement rate. Interestingly enough,
there were studies where women with multiple cesareans had
lower uterine rupture rates during labour than women with
only one cesarean, with the (ab)use of induction drugs being
the main difference. If a mom in Edmonton could have 3 perfectly
safe vaginal births after 5 cesareans (a 3VBA5C mom), all
at home, what is stopping the rest of us? In Netherlands
, vaginal birth after cesarean is so normal that they do
not even have a word for it. The term VBAC to them is as
meaningless as if we said VBAT, vaginal birth after tonsillectomy.
I wish we were all just birthing moms.
“The Safety of Vaginal Birth”,
Mary Sagady
The relative safety of elective cesarean
surgery is always a common topic. How come we never hear
about the safety of elective vaginal birth? This speaker
postulated that if we promoted elective vaginal birth, in
the same elective cesareans are promoted, first-time mothers
who are undecided would flock to caregivers that would help
them have a vaginal birth in order to ensure: the releasing
of ALL of the hormones the baby needs to live outside the
womb, the massaging of the baby's organs during the passage
through the slippery vagina, the leaving of the mother's
womb/bladder/abdomen intact and healthy after birth, and
the side benefits of getting ALL the maternal hormones that
aid breastfeeding, aid bonding and reduce postpartum depression.
I'm sold!
“The Illusion of Choice in Childbirth”,
Henci Goer
This is the author of my favourite book “Obstetrical
Myths Versus Research Realities: A Guide to the Medical Literature” which
proves with loads of medical research why we need to avoid
as many routine obstetrical interventions as possible. Ms.
Goer helped write the 2004 “What Every Woman Needs to Know
About Cesarean Section” booklet available for free at www.maternitywise.org .
She explained that if your hospital or caregiver prohibits
VBAC, waterbirth, anyone labouring for longer than 24 hours,
being overdue longer than 7 days, birth without episiotomy,
the use of doulas, or the practice of midwives, then you
don't have those choices. Forced cesareans because of hospital
and caregiver restrictions happen everyday, but medical files
or statistics do not reflect that. Many women discover after
ordering a copy of their hospital records, that their mandatory
cesarean was labeled as patient-elected cesarean. These mistakes
legally shift the responsibility for the birth on the mother,
not the doctor.
“The Pain of the Witness”, Jamie
Stouffer
Everyone knows the negative emotional effects
that “bad” births can have on the mother. What about the
effect on the witnesses to the birth? Fathers and doulas
also need to process the birth and find support. Writing
the birth story and attending post-cesarean support meetings
are an ideal place to start the healing. By the way, let's
remember that the baby needs healing too. Therapy on newborns
that display signs of stress can begin right away.
“Everything You Want To Know About
Uterine Rupture But Were Afraid To Ask: The Latest Findings”,
Nicette Jukelevics
Preventing uterine rupture is the reason
why the medical (and legal) establishment encourages repeat
cesareans over VBAC. Unfortunately some statistics estimate
that 199 women would need to undergo risky cesareans in order
to prevent only 1 uterine rupture, regardless if the rupture
is small, has no symptoms, has healed, and the great majority
of babies and mothers come out fine. Women with zero cesareans
have a near zero uterine rupture rate, therefore it is the
first cesarean which cause future ruptures, while one VBAC
actually strengthens the womb reducing its future exposure
to ruptures. Preventing cesareans should be the ideal goal.
“The Passion of Birth”, Barbara
Harper
This is the author of my other favourite
book “Gentle Birth Choices: A Guide to Making Informed Decisions
about Birthing Centers, Birth Attendants, Water Birth, Home
Birth, and Hospital Birth”. She had slide after slide of
families having water births in pools, rivers, lakes and
oceans; and of dads catching their own babies, moms relaxing
in the water with their newborns, with the siblings calmly
watching. She asked that we send a message:
To all birth advocates: stop eating
sugar and start walking everyday because you cannot get
diabetes or heart disease and die early. You need to
live a long time to continue telling women how beautiful
and powerful birth can be.
When conference attendees from the U.S.
discovered that I was from Canada , they told me how much
they admired us for having lower cesarean rates and VBAC
guidelines that were more flexible than theirs. I quickly
corrected them by saying that our medical establishment,
with some minor exceptions, is trying very hard to copy the
U.S. believing it has better maternity care. Going unchecked,
Canada can become as restrictive on childbirth choices as
the United States is, and therefore we need to become alert
when any choice is modified, reduced, restricted or prohibited.
High cesarean rates do not translate into best outcomes for
birth. The developed countries with the best outcomes in
birth, such as Netherlands , have the lowest cesarean rates.
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