NICHD Seeking Beta Testers for PregSource Data Collection Tool

November 24th, 2015 by avatar

Become a PregSource Beta TesterLamaze International frequently collaborates with stakeholders, researchers and other organizations who share an interest in maternal child health and improving maternity care for families both in the USA and internationally.  As part of this collaboration, Lamaze International would like to ask for your help in recruiting pregnant people, people who were pregnant in the past year or even those who are thinking of becoming pregnant to participate as beta testers before the PregSource data collection tool is launched to the public.

The objective of PregSource: Crowdsourcing to Understand Pregnancy (PregSource) is to better understand the range of physical and emotional experiences and alterations in behavior that women have during pregnancy and after giving birth, the impact of these experiences on women’s lives, and the perinatal challenges encountered by special sub-populations of women.

To advance these efforts, here is a some wording that you can use to invite class members, clients and patients to participate in the PregSource beta testing.  You are free to use this letter as is, or modify to suite your needs.  This would be a great news tidbit to include in your regular e-news, social media postings and share with your classes.

The information obtained from this study will be helpful in improving prenatal care for women.  Help Lamaze International and their research partners to successfully test this program.  Your effort is greatly appreciated.

Sample Letter

Lamaze International is partnering with Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health, on a project called PregSource. PregSource is a crowdsourcing research effort that aims to improve understanding of the range of physical and emotional experiences that women have during pregnancy and after giving birth.

Because PregSource relies on crowdsourcing, we will be gathering information directly from pregnant women themselves, asking them to enter information about their pregnancies and the health of their babies into online questionnaires. Women who use PregSource can view how their responses compare to other PregSource participants, print or email reports to share with their health care team, and receive information from trusted sources on pregnancy-related issues.

PregSource is currently looking for beta testers to help ensure that the online platform is appropriate and that it is working correctly. If you or someone you know is pregnant, thinking about becoming pregnant, or were pregnant in the last year—we want YOU! Your assistance is critical to ensuring that PregSource can meet its goals. Please note that for the pregnant beta testers, we will need to verify some of the information using a copy of their medical records. We are committed to keeping all personal information secure and will destroy the medical record as soon as we have verified the information.

 If you are interested, please send your name, stage of pregnancy (or if already delivered) and email address to the NICHD at PregSource@nih.gov

We value your participation and your interest in helping us launch PregSource.

Childbirth Education, Lamaze International, Research, Research Opportunities , , ,

Series: Brilliant Activities for Birth Educators – Events of Late Pregnancy and Premature Birth

November 19th, 2015 by avatar

PlaybillNovember is Prematurity Awareness Month and November 17th was World Prematurity Awareness Day. This month’s Brilliant Activities for Birth Educators post is about preventing prematurity, the events of late pregnancy and the importance of waiting for labor to begin on its own. As they do every year, the March of Dimes leads the way in recognizing the importance of preventing premature births. They have provided information and resources to bring this important problem to light.  The number one cause of death of young children worldwide is complications from being born too early, with estimates of 1.1 million deaths directly linked to being born too early.   In the United States, one in ten babies are born premature.  If you live in the USA, you can check out how your state has performed on the prematurity report card.  On the international level, you can find out how your country ranks here.  In the US, we also know that premature births and low birth weight babies are more likely to occur in families of color.

I cover premature birth in my childbirth classes in many ways, including recognizing the signs of premature labor, and facilitating a discussion around the Lamaze Healthy Birth Practice “Let Labor Begin On Its Own” as induction before a baby is ready and has started labor can unintentionally result in a premature birth if the gestational age is estimated incorrectly or even if the baby was not ready and needed some more time in utero.  Not every baby is ready to be born at the same time.

My favorite activity to do in class on this topic leaves families really understanding the benefits of letting baby start labor when they are ready (in the absence of medical complications).  In small groups – the families prepare and present a short skit on the events of late pregnancy.

When this is activity is done in class

I cover this information on week two of a seven week series, at the beginning of class.  The families are just beginning to gel and we have done quite a bit of interactive learning the week before, on class one, but this is definitely a leap of faith on their part to be doing such a “daring” activity at the start of the second class.  They have only been with me and their classmates for one 2.5 hour session.  I am asking a lot of them, but they always rise to the challenge.

© Penny Simkin

© Penny Simkin

How I introduce the topic and set up the activity

I hand out Penny Simkin’s “Events of Late Pregnancy” information sheet that is available for purchase as a tear pad from PennySimkin.com. I discuss how both pregnant person and baby are getting ready for birth in the last weeks of a pregnancy.  Many different processes are happening and systems are moving forward to have everything culminate and coordinate in the labor and birth.  Each and every process is critical to a healthy baby and a body that is ready for labor.  I divide the class into four groups and assign each group to be either a Pregnant Person, Uterus, Fetus, or the Placenta/Membranes.  I ask them to collaborate together and prepare a skit, activity, active presentation, interpretive dance, charade etc., that shares information on the changes their assigned role undergoes during the last weeks of pregnancy and through labor.  I give them around five minutes to prepare and offer to provide any props that they might need from my teaching supplies.  They gather their groups, take their tear sheet and head to four corners of the classroom to get to work.

The results of their creativity

After the small group work is completed, we gather back as a class and get ready for the “show.”  In turn, each group (and their chosen props) heads to the front of the room to do their presentation.  Everyone follows along with their info sheet.  The results are outstanding and usually quite comically.

Some of the most memorable presentations have included a newscaster holding a microphone and interviewing the fetus at different gestational ages.

Newscaster: “Hello 34 week old fetus, can you tell me what you are working on now?”

Fetus: “Well, this week, I am taking on iron and my mother’s antibodies. I need the iron to help me through my first six months and the antibodies protect me until I can make my own. ”


© Anne Geddes and March of Dimes

Other groups have created a giant pelvis with their bodies and had a “baby” assume the birth position and move through.  I recall a group ripped up red paper into confetti, and released it from up high to represent bloody show.  Just this week, one group did a hip hop dance and chanted along with the different events.  “Antibodies” have leapt through “placentas,” and fake breasts have leaked colostrum.  Giant uteri have contracted and pushed babies out.  One week, uncoordinated contractions representing Braxton-Hicks contractions “squeezed” out of sync and then got “organized” and worked in unison to represent labor contractions getting longer, stronger and closer together, flexing and squeezing like a well fabricated machine. I am continually amazed at the creativity and ingenuity of the results.  Everyone laughs and best of all, the events are memorable and easy to recall.


After each group has a chance to present their section, we debrief and discuss any questions.  We bring things full circle by talking about what the impact might be for a premature birth or a birth that occurs before the baby or parent’s body is ready.  Everyone is clear that the process of birth and the transition that baby needs to make works best when baby chooses their birth day.  We admire everyone’s creativity and laugh about the mad skills that the class has!  As the series continues, I can refer back to these skits and remind them of the important steps as they come up again in class.  I am amazed that they have great recall of the progression.

What the families say about the activity

After we have finished, the feedback I receive on this activity is great!  Despite their initial hesitancy to get so far out of their comfort zone, families really remember the events, recognize how important the changes are that occur in the pregnant parent, the uterus, the baby and the placenta and membranes. They can clearly articulate why it is important to reduce the chance of a premature baby and wait for labor to start on its own.  The unique presentations really make things memorable and the families report back to me weeks later, or even at the class reunion after birth, how they often thought of this activity and it helped them to have patience to wait for baby to come.  They knew good (and important) things were happening in the last few weeks that would make for a healthy birth and baby.

How do you teach about preventing premature birth and the importance of waiting until baby starts labor?  What interactive teaching ideas do you use?  Do you think that you might try something like this in your childbirth classes?  How might you modify it.  Share your thoughts in the comments below.  I would love to hear from you.

Babies, Childbirth Education, Healthy Birth Practices, Lamaze International, Newborns, Pre-term Birth, Series: Brilliant Activities for Birth Educators , , , , ,

Meet Maria Brooks – New President of Lamaze International

November 17th, 2015 by avatar

“A Lamaze educator is able to anticipate a need that you may have before you experience it. She can tailor your class to help you navigate obstacles that are unique to your health and choice of birth location.”  – Maria Brooks, President, Lamaze International

maria brooks headshot 2015This fall, Maria Brooks, BSN, RNC-OB, LCCE, FACCE moved into the position of President of the Board of Directors and began serving her one year term leading our organization.  Maria (pronounced “Mah-rye-ah”) has been serving on the BoD since 2012 and also serves on the Lamaze ITS Steering Committee and Lamaze Membership Committee.  Maria is an L&D nurse at Pennsylvania Hospital in Philadelphia.  While I have known Maria for several years, I recently connected to ask some questions on behalf of Science & Sensibility readers.  I know that all of our Board works very hard on behalf of educators and parents.  Please join me in congratulating Maria and welcoming her into her new position. .

Sharon Muza: What are some of the opportunities and challenges that face our organization currently and what plan do you and the board have to meet these challenges?

Maria Brooks:  Exaggerated fears around pregnancy and childbirth have already taken hold in many women by the time they reach our educators. One of the ways Lamaze is trying to help make a difference is developing a para-professional community trainer/model for Lamaze education. A Lamaze peer educator program is an opportunity for Lamaze International to promote evidence-based healthy behaviors before, during, and after pregnancy among 18-25 year old young adult women.  The peer educator program will be designed to train college-aged women using a scripted toolkit to disseminate information on the Lamaze Six Healthy Birth Practices.  The purpose of the peer educator program will be to share information to help young adult women to formulate accurate and confidence-building ideals about pregnancy, birth, and breastfeeding. We plan to pilot the program in the coming year.

“Maria brings a depth of advocacy skills and passion for reaching women and their families in diverse communities with Lamaze education and resources. I look forward to working with Maria, the Board of Directors, and volunteer leadership as we continue the meaningful work of advancing Lamaze’s strategic imperatives in the coming year.” – Linda Harmon, Executive Director, Lamaze International

SM: When you think of the many recent accomplishments of Lamaze International, what are a few that you are most proud of? Why?

MB: In the last few years, Lamaze has made it a priority to “create demand for our brand.” We want to meet women where they are – online! We have seen a tremendous growth in our reach through our expanded presence on social media by hosting monthly Twitter chats and creating content-rich infographics and videos to share via Facebook, Pinterest, our blogs, Twitter, and so much more.  These efforts have raised our social media presence and profile. Both Science & Sensibility and Giving Birth with Confidence have been recognized for their high-value content and have seen significant growth in reach over the past few years reaching more expectant parents and professionals with evidence-based information. That alone is a big success. We are lucky to have these blogs represent the mission and vision of Lamaze. Lamaze also invested in development of a mobile app for expecting families, Pregnancy to Parenting, to make Lamaze education resources easily accessible on the go, and as a resource for our educators to use in class.  

SM: Do you feel that Lamaze is recognized as a serious player amongst maternal infant health organizations?  If yes, what accomplishments have helped us to earn this position and a seat at the table working with other well known organizations to improve maternal and neonatal mortality and morbidity?

MB: Yes, Lamaze has had a seat at the table with other maternity care players.  A recent example was being tapped this past year to work with National Institute of Child and Health Development (NICHD) and other key maternity care groups on the development of a new pregnancy registry.  We also have plans to host a Roundtable discussion on childbirth education with key stakeholders.  

Lamaze International offers the only childbirth educator certification program that has been accredited by an outside body, the National Commission for Certifying Agencies (NCCA),  which has reviewed and vetted the standards Lamaze employs in administering our certification exam.  Maintaining certification is equally important for ensuring LCCE educators stay up to date with the latest on evidence-based practices, adult education, teaching and advocacy strategies.

SM: What plans are in the works for the Lamaze International organization that will benefit families as they prepare to welcome a child?

MB: Quality childbirth education is still not available to many women. These are the very women who often have the poorest outcomes with the highest rates of unnecessary interventions. This has to change. If high-quality childbirth education was offered to all women no matter the social economic or educational background, this disparity will change. It is a priority to advocate for insurance coverage and reimbursement to pay for childbirth education. In March 2015 members of the board of directors met with legislators about the importance of all women receiving childbirth education. Currently the Affordable Healthcare Act allows enrollment at the time of birth.  We asked legislators to change the life event designation to pregnancy, to allow childbirth education to be a part of prenatal care and covered by health care insurance. We still have a lot of work to do but this initial step into policy advocacy is a positive move in the right direction.

Hear Maria talk about her birth experience in Lamaze International’s “Push for Your Baby” video.

SM: What about plans and programs for educators?  What can members expect to see from Lamaze during your term that will benefit LCCEs and offer opportunities for those that teach?

MB: Lamaze offers LCCE members a rich array of evidence-based resources to support their professional development, such as regular webinars on current hot topics, The Journal of Perinatal Education with home study modules, the new Business Toolkit and Social Media Guide.  The organization has also invested in developing teaching tools to support Lamaze educators, including the Lamaze Toolkit for Childbirth Educators, infographics, the new mobile app, online parenting classes to supplement in person classes.

SM: As both a Lamaze Certified Childbirth Educator and a L&D Nurse, do you find it necessary to keep both roles separate and wear two hats?  Is there any overlap?  What challenges do you face because of your dual roles?

MB: I love the opportunity to wear both hats, and I am very lucky to work in an environment that looks positively on the Lamaze Six Healthy Birth Practices. So no, the two roles do not conflict but each does sharpen the other. As a nurse, a large part of my job is to educate my patients and to help them make informed decisions about their health care. As a LCCE educator, I’m fortunate to have more time to build a relationship and rapport with my students before the actual birth day, but as a nurse, my “classroom” looks a bit different. It may be in triage when I have a mom begging to stay when she is in early labor or not in labor at all. I take that time to let her know the importance of waiting on labor and how every day counts for that little person growing inside her. Or it might be in the labor room with a family who for whatever reason did not take a childbirth preparation class and needs help knowing how to comfort their partner or friend. I spend time helping new mothers to see how powerful they are and how smart their babies are. I also find myself in a special place to help teach my fellow nurses non-pharmacological pain management, allowing them to also feel empowered to work with these families. And of course, I encourage my colleagues to become LCCE certified themselves. I’ve never felt more at home than when wearing both ”hats”.

SM: Why should families continue to attend in person classes when so many online options exist and the internet offers a multitude of learning opportunities and virtually unlimited information for the pregnant person and their family?

MB: The internet has a lot to offer and can be a great complement to a classroom, but nothing replaces a quality in-person class. A Lamaze educator is able to anticipate a need that you may have before you experience it. She can tailor your class to help you navigate obstacles that are unique to your health and choice of birth location. Being face to face with other families also gives an opportunity to  build relationships that grow deeper as your family evolves. Some of my best friends today I met in my Lamaze class. We shared a chuckle not long ago that the person in the class that asked the most questions is now the President of Lamaze!

SM: Tell us something unusual about you that we might never know!

MB: I am a classically trained actor and dancer and worked as a stage actor in New York City for over ten years.

Childbirth Education, Healthy Birth Practices, Lamaze International, Lamaze News, Push for Your Baby , , , , , ,

Series: Supporting Women When a VBAC Doesn’t Happen – Part Three: Supporting The Mothers

November 12th, 2015 by avatar

By Pamela Vireday

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

cbac part 3Today we conclude our three part series on Cesarean Birth after Cesarean, written by Pamela Vireday, who is an occasional contributor to Science & Sensibility.  In this series, Pamela examines the topic of women who experience a Cesarean Birth after a Cesarean. This is when families are planning for a vaginal birth after a prior cesarean, but the birth does not go as planned.  The experiences of women who have a CBAC are often negated and their emotional and physical well-being given short-shrift by both professionals and their social community of friends and family.  The research on this topic is slim and begs for exploration by qualified investigators.  Last week, Pamela discussed the unique grief that CBAC women may experience. Two days ago, Pamela examined the limited research available on CBAC births in part two.  Today, Pamela will provide information on how to support CBAC women in the absence of published research.  There is also great set of resources in the post to share with the families you work with or include in a CBAC Resource packet you provide after birth. You can also read a companion piece of Pamela’s own personal story, “Cesarean Birth after Cesarean, 18 Years Later” on her own website.- Sharon Muza, Community Manager, Science & Sensibility.

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 was 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 is 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 health care 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

CBAC Support Groups

General Birth Trauma Support Organizations

Articles on CBAC Recovery

Birth Trauma Articles



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

About Pamela Vireday

Painting by Mary Cassatt, 1844-1926. (public domain) Image from Wikimedia Commons.

Pamela Vireday is a childbirth educator, writer, woman of size, and mother to four children. She has been collecting the stories of women of size and writing about childbirth research for 20 years. She writes at www.wellroundedmama.blogspot.com and www.plus-size-pregnancy.org.


Cesarean Birth, Childbirth Education, Guest Posts, Maternal Mental Health, Maternity Care, Medical Interventions, PTSD, Series: Supporting Women When a VBAC Doesn't Happen, Vaginal Birth After Cesarean (VBAC) , , , , , , ,

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

November 10th, 2015 by avatar

By Pamela Vireday

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

CBAC part 2We continue our current series on Cesarean Birth after Cesarean, written by Pamela Vireday, who is an occasional contributor to Science & Sensibility.  In this series, Pamela examines the topic of women who experience a Cesarean Birth after a Cesarean. This is when families are planning for a vaginal birth after a prior cesarean, but the birth does not go as planned.  The experiences of women who have a CBAC are often negated and their emotional and physical well-being given short-shrift by both professionals and their social community of friends and family.  The research on this topic is slim and begs for exploration by qualified investigators.  Last week, Pamela discussed the unique grief that CBAC women may experience. Today, Pamela examines the limited research available and part three (on Thursday) will provide information on how to support CBAC women in the absence of published research.  We will also conclude the series with a useful resource list to share with the families you may work with who find themselves in this situation.  You can also read a companion piece of Pamela’s own personal story, “Cesarean Birth after Cesarean, 18 Years Later” on her own website.- Sharon Muza, Community Manager, Science & Sensibility.


In Part One of the series – Supporting Women When a VBAC Doesn’t Happen, 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 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 afterwards. This can greatly complicate emotional processing, but sadly, these are often the mothers who receive the least emotional support afterwards. 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.


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

About Pamela Vireday

Painting by Mary Cassatt, 1844-1926. (public domain) Image from Wikimedia Commons.

Pamela Vireday is a childbirth educator, writer, woman of size, and mother to four children. She has been collecting the stories of women of size and writing about childbirth research for 20 years. She writes at www.wellroundedmama.blogspot.com and www.plus-size-pregnancy.org.


Cesarean Birth, Childbirth Education, Guest Posts, Maternal Quality Improvement, Maternity Care, Medical Interventions, Research, Series: Supporting Women When a VBAC Doesn't Happen , , , , , , ,

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