Series: Supporting Women When a VBAC Doesn’t Happen – Part One: A Unique Grief

November 5th, 2015 by avatar

By Pamela Vireday 

“Although the world is full of suffering, it is also full of the overcoming of it.”  –Helen Keller

CBAC part 1I am delighted to share with you a three part series that begins today, 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.  Today, Pamela discusses the unique grief that CBAC women may experience.  Part two will examine the limited research available and part three 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.

It is a hard truth that not all women who want a VBAC will have one.

In a typical high-intervention hospital setting, about 60-80% of women who attempt a VBAC will have one. (Grobman 2010) That’s a terrific, strong reason to support VBACs.

The underappreciated flip side of this statistic, however, is that about 20-40% of women who attempt a VBAC will have another cesarean instead, often after a long, hard labor. Yet little attention has been paid to these women and their families. How do they feel about their experience? How is their emotional journey different than after a primary cesarean or an elective repeat cesarean? What do these women need to integrate this experience into their lives?

Anecdotally, many women report that they did not feel supported after a VBAC attempt  (referred to as TOLAC – Trial of Labor after Cesarean) that ended in another cesarean. Some even felt judged or deserted by their care providers and friends. Research shows that the physical recovery is often harder, too. Yet little attention has been paid in the research to the needs of these women, and few resources exist that directly address their experiences.

Where is the support for women who have an undesired, unplanned second cesarean? Where is the acknowledgement of all the work they put in towards a VBAC, the hours of labor, the pain, the worry? Does all that preparation and work not count if one does not end up with a VBAC?

How can we in the birth field better support the women who do not have a VBAC? How can we help all mothers feel supported, regardless of outcome?


The first thing that we can do is to be mindful of our terminology.

Obstetric research typically uses the terms “Failed VBAC” or “Failed Trial of Labor After Cesarean” (Failed TOLAC). Many women feel that this terminology is judgmental and insensitive, adding to their emotional wounds at a time when they feel most vulnerable. Women who did not get a VBAC are not failures. The reality of birth is much grayer than a black-or-white, success-or-failure binary equation.

The term, “trial of labor cesarean,” is a better alternative than “failed VBAC.” However, it is cumbersome and perpetuates the mentality of being “on trial.”

Members of the International Cesarean Awareness Network (ICAN) created the more-neutral term “Cesarean Birth After Cesarean” (CBAC) as an alternative. It helps distinguish between a repeat cesarean that was gladly chosen and one that occurred when a mother planned and worked for a VBAC but didn’t get one.

Most of the time, CBAC refers to a woman who labored and then had a repeat cesarean. However, sometimes CBAC can also refer to an unwanted repeat cesarean performed before labor for legitimate medical reasons, because the mother was coerced or scared into a repeat cesarean, or because she was unable to find a supportive provider. The point is that an undesired cesarean is going to have a different emotional resonance than one which was wanted.

Some women prefer “CSAC” (Cesarean Surgery After Cesarean). We will use “CBAC” here because its meaning is intuitive and it is a logical companion term to “VBAC” but women should choose the term that feels right for their experience.

Women’s Stories

Women who have had CBACs often report that they did not receive adequate emotional support from birth professionals, friends, or family after the birth.

“When it comes to support, I had tons when PLANNING the VBAC but once it turned into a CBAC? Everyone disappeared. No one was willing to talk to me about it. No one really had information to GIVE me about a ‘failed VBAC.’ “Sarah Vincent

“I remember after my failed [VBAC] attempt how much I needed to share my story, talk about my disappointment and sadness, and process what went wrong. But it seemed as though nobody wanted to hear it. It was almost as if my CBAC might be contagious so I should refrain from talking much about it.” Teresa Stire

Personally, I had a CBAC after 5 hours pushing with no progress. My doula made me feel like I had given up too soon. She left soon after the cesarean and I never saw or heard from her again, despite the fact that she was supposed to do a postpartum visit. Her abandonment spoke volumes. Sadly, her judgment was only the first of many from the birth world.

CBAC mothers often feel their decisions are second-guessed like this. Well-meaning people will go through a CBAC mother’s birth story, looking for “wrong” decisions that caused the CBAC. Sometimes CBAC stories are used as cautionary tales to other hopeful VBAC mothers. Even when there are things a CBAC mother might have changed about her decisions, being held up as an example of “what not to do” is incredibly hurtful.

Furthermore, the grief around a CBAC is different in some ways than that around a primary cesarean; women tend to feel more “broken” after a CBAC, as if their bodies had truly failed them, and many feel isolated and unsupported. Yet the birth community treats CBACs as if they are no different from primary cesareans. CBAC mothers have shared:

“I personally felt screwed by careproviders after my 1st CS, but after my 2nd I felt screwed by my body― I truly was broken.” Elaine Mills

“The isolation of CBAC is another aspect that may be relatively unknown. I felt very isolated ― from vaginal birth moms, from Elective Repeat Cesarean moms (ERCS) moms, and very much from VBAC moms. This has been very toxic for me.”   Rebecca H.

“Validating the…compounding nature of that loss (as opposed to a primary c/s) ― the nail in the coffin feeling ─ is so important.” Caroline Kelley

A CBAC is not experienced in the same way as a primary cesarean or an elective repeat cesarean. The grief resonates differently, even if the CBAC was prudent or necessary. Yet seldom is the unique nature of this loss acknowledged. How can we, as birth professionals, recognize these differences and support these women through this emotional journey? More on this in the Part Two of the series on Tuesday.


Grobman, W. A. (2010, August). Rates and prediction of successful vaginal birth after cesarean. In Seminars in perinatology (Vol. 34, No. 4, pp. 244-248). WB Saunders.

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, Series: Supporting Women When a VBAC Doesn't Happen, Vaginal Birth After Cesarean (VBAC) , , , , , , , , , , ,

Lamaze Parent Satisfaction Survey Will Benefit Families – Educators Play a Key Role in Increasing Response Rate

November 3rd, 2015 by avatar

VoteSurveyParticipation at in-person childbirth education classes has been on the decline in past years.  There has not been much research on the benefits of taking a childbirth class, and with the plethora of information available online, it is no surprise that enrollment may very well be on the decline.  At the same time, cesarean rates and obstetrical interventions have overall been increasing.  Maternal and neonatal morbidity and mortality rates have not been improving either.

In the 2013 Listening to Mothers  (LtM) III report, 59% of all first time mothers took childbirth classes, compared with 70% in the 2002 LtM I report.  In 2013, 17% of experienced mothers took classes, down from 19% in 2002 (Declercq, 2013, Declercq 2002).

Lamaze International, with its diverse and experienced team of Lamaze Certified Childbirth Educators, is in a unique position to collect data on the experiences of parents who take Lamaze childbirth classes and utilize Lamaze International resources.  The Lamaze staff and Board of Directors have developed and initiated a Parent Satisfaction Survey that can be filled out by families who have completed a Lamaze class.  The survey is meant to be completed after the birth of their baby, so that the information can be used to determine how their Lamaze class impacted their actual choices and experience.

The information being collected in this Parent Satisfaction Survey can play a key role in helping to:

Understand the impact of Lamaze classes

Data collected through these surveys can be used to understand the impact of Lamaze classes on families and birth outcomes and guide further research on this topic. Exploring this area of research can help Lamaze and other organizations to access funding to further develop and continue studying this important topic

Lobby for improved access

Information gained through these post-birth surveys  can be used to educate lawmakers on the outcomes of births when families participated in birth classes and encourage legislators to offer reimbursement and increased access for childbirth education classes across all socioeconomic and ethnic categories. Lamaze International plans to repeat their “Hill Day” campaign and lobby Congressmen/women in early spring of 2016 by visiting them in their D.C. offices and sharing information about maternal infant health and outcomes experienced by parents and infants during the childbearing year.

Improve information and educational materials

The results of the survey can help Lamaze International to be sure their message is on target and their educational materials are effective in sharing information on best practices, evidence based care and informed consent and refusal.  Lamaze can continue to develop curriculum and services that help families to “Push for Their Baby” during pregnancy, birth and postpartum.

Help LCCEs to deliver education

Every childbirth educator’s goal is to communicate important information to expectant families through engaging and effective activities.  Aggregated survey information can help Lamaze International provide information and direction to all the LCCEs so that they can assess how they can continue to provide valuable and useful information to the families participating in their Lamaze classes.

Share the message with other stakeholders

Information gleaned from the survey will be shared with policymakers and key third-party organization stakeholders at upcoming roundtables that Lamaze representatives facilitate in and host.  It is important for health care providers, hospital administrators and maternal infant health organizations to recognize how effective Lamaze childbirth classes can be be in creating a safe and healthy birth for participating families.

Linda Harmon, Lamaze International’s Executive Director took a moment recently to answer some questions about the Parent Satisfaction Survey.

Sharon Muza:  There is not a lot of research available on the effectiveness of childbirth/Lamaze classes.  Do you feel this information could be used as the basis of that research?

 Linda Harmon: Lamaze has commissioned a White Paper which will present the evidence related to childbirth interventions overuse in the US hospital system, and the effects they can have on childbirth outcomes, and present the argument that evidence-based prenatal education is a critical avenue for women when making childbirth care decisions.  The parent satisfaction survey will support this research by providing data from the parents who have used Lamaze resources.

SM: How could the information gained from this survey be used to further reimbursement for families who take childbirth classes?

LH: Data gained from the Lamaze Parent Satisfaction Survey will be used to provide important insights about the impact of Lamaze childbirth education on the experiences and outcomes of pregnant women and their babies. These insights will provide valuable information to support discussions with healthcare insurers, hospitals and other strategic partners to advance Lamaze education.  Preliminary data from the Lamaze national parent satisfaction survey shows that women engaged with Lamaze have a cesarean rate of 20%. That’s about 13% less than the national cesarean rate of 33%.  If a 13% reduction in cesarean could be translated across the U.S., the potential cost savings would be nearly $4.7 billion annually.

SM: Lamaze International is an international leader in childbirth education and offers a great curriculum filled with best practice and evidence based information.  Have initial survey responses indicated that our classes have been a useful component for families welcoming a child?

LH: The preliminary data is very positive, but we need substantially more parent survey responses to  validate general trends. In the initial review of survey findings in March 2015,  we compared what women told us in the Lamaze survey with what women reported in the highly-respected national survey Listening to Mothers III: Pregnancy and Birth.  Early survey responses show that 94% of women taking Lamaze classes say that education provided by Lamaze improved their childbirth experience and 91% feel well informed about decisions in labor and birth.

You Can Help Advocate for Childbirth Education

Lamaze Certified Childbirth Educators play a key role in getting the word out to the families who participate in their classes.  Through information received from you, families can be directed to the survey and asked to participate.  During the online survey, participants are asked a handful of simple questions that seek to learn if childbirth education improved their birth experience.

Lamaze has put together many resources for LCCE educators to help you understand the importance of this survey.  These resources include:

  • An FAQ to help you become familiar with the survey and encourage you to participate.
  • How to introduce the survey in class – We have created sample messages and instructions for  encouraging your students to sign up for the survey
  • Promote the survey – We have developed a sample email you can send your class, introducing them to the survey, as well as sample Facebook, Twitter and blog posts.

Every family that participates in the survey will receive a coupon for a discount on a Lamaze toy.

Win a 2016 Lamaze International conference registration

If you encourage participation, you will be entered to win a complimentary Lamaze International 2016 Annual Conference registration. If your name is referenced as their childbirth educator in the survey, you will be entered in the drawing—and the more your name is referenced, the more entries you will have!  This is a real bonus reason to share the survey with parents, even beyond the benefits to research and programs. 

 Are you already encouraging your families to take the Parent Satisfaction Survey?  Share your experiences in the comments section.  If you have not yet begun to communicate information to your families about the survey, I hope that you will reconsider as you recognize the importance of your role in collecting this valuable data.


Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2013). Listening to Mothers III: Pregnancy and Birth; Report of the Third National US Survey of Women’s Childbearing Experiences. New York, NY: Childbirth Connection.

Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Risher, P. (2002). Listening to mothers: Report of the first national US survey of women’s childbearing experiences. New York.

Babies, Cesarean Birth, Childbirth Education, Lamaze International, Lamaze News, New Research , , , , , ,

Series: Brilliant Activities for Birth Educators: Trick or Treat – Halloween Spoils Make Great Teaching Aids

October 29th, 2015 by avatar

By Stacie Bingham, LCCE, CD(DONA)

pelvis title BABEOctober’s Brilliant Activities for Birth Educators honors the Halloween holiday as educator Stacie Bingham takes us down the Halloween aisle for items you can use to make props for teaching families about baby’s movement through the pelvis.  Stacie is a creative educator who is always coming up with new ways to introduce families to concepts that help them to have safe and healthy births.  I would also like to take a moment to congratulate Stacie on passing the recent Lamaze exam and earning the credentials Lamaze Certified Childbirth Educator.  Way to go Stacie!  Enjoy this month’s Brilliant Activities for Birth Educators post and consider checking out past posts as well for other great ideas.  Happy Halloween! – Sharon Muza, Community Manager, Science & Sensibility

I am crafty and cheap frugal; finding alternatives to traditional (costly!) childbirth education supplies is one of my favorite pastimes. I wander thrift stores, clearance aisles, even the market where I buy groceries, always thinking: what could I do with this? It has enabled me to build up a collection of props to support my classes at very little cost, while also giving me more wiggle room in my budget for items that must be purchased, such as media and print resources.

skeletonMake your own mini pelvis, placenta, umbilical cord and amniotic sac

Last October, I had the idea of creating a miniature baby/pelvis model from a Halloween skeleton. I made a trip to my local superstore and purchased a skeleton, and then my labor began. I had a tiny baby doll, I believe it is a Barbie baby from sometime in the past 20 years (it was my little sister’s, swiped acquired by me on a visit to my mom’s house). I started digging around my house to see what else would work. My supply list ended up as follows:

  • Skeleton (I used a 10 inch one in this example)
  • Doll that fits through skeleton’s pelvis
  • Embroidery floss, blue and red
  • 1 Orthodontic rubber band
  • Needle and thread
  • Reddish fabric for placenta
  • Plastic baggy (amniotic sac)
  • Washi tape
  • Tiny baby sock (uterus)

How to assemble the pelvis

I started by separating the pelvis from the torso with scissors. I boiled some water on the stove and submerged the pelvis in while holding on to the legs. Every so often I would pull it out and work to widen the pelvis. I used scissors, although other tools would work as well. After repeating this a few times, re-submerging and working again, the pelvis shape was to my liking. Then I used a utility knife to further excise the remaining segments of the spine.

Stacie BABE3How to assemble the umbilical cord and placenta

For the umbilical cord, I used three strands of embroidery floss, which I braided together. To make the placenta, I took two small squares of fabric (leftover from a quilting project), and cut a circle shape. I turned the fabric prints to face each other, and then I began to sew. I left a small opening so I could turn the fabric right-side out (I found a straw handy to help poke out all the places I couldn’t reach with my fingers), and then I closed the hole with a couple of small stitches. At this point, I took the “cord” and threaded it through the needle (did I mention I used a very large needle?). Carefully inserting the needle through the side of the placenta between stitches, so it would disappear into the placenta, I poked the needle out through the middle of one layer of the placenta, anchoring it into place and allowing the cord to attach from that spot. I wasn’t sure how I would link the baby to the cord, which is where the orthodontic band came into place. It is clear and fit snugly around the baby’s belly. Since there was a tiny knot in the end of the cord, I simply tucked it under the band.

Stacie BABE2How to assemble the amniotic sac

For the amniotic sac, I turned to a clear plastic baggy. I cut it into a u-shape and used Washi tape to seal the edges. It is a bit disconcerting to see a baby in a plastic bag, and there are so many other things you could use – one item that comes to mind is an organza bag you might get candies or favors in at a wedding or shower. The final touch was, using one of my baby’s socks for the uterus, and, voila!

How I use it

I love the idea of table-top props, those designed to be used as you sit across the kitchen table from a couple during a private class. The tiny pelvis and baby fits easily into my bag with the curriculum, handouts, and other supplies I may need, saving me from dragging my big set along.  If you are talented enough, consider making many sets of them, and providing each family a set to use in your group classes.

What the families say

Families enjoy getting to manipulate the baby through the pelvis as you take them through the class content. Often parents are delighted to see such a small little baby and pelvis, and they want to touch and try, passing the baby through the bones. The benefit of seeing and navigating the baby through the pelvis with these teaching aides supports two of the Lamaze International Healthy Birth Practices, #2: “Walk, move around and change positions throughout labor”  and #5 “Avoid giving birth on your back and follow your body’s urges to push.” For some parents, this is the first time this idea has been not only explained, but more importantly, demonstrated.  The little kit is always well received.


I am sure this design could be improved upon, and I would love to hear your ideas! It took me less than an hour and about $5 to complete this project — I was only limited by my imagination and what was lying around my house (as a personal challenge). This Halloween season, I also purchased three boxes in the shape of (haunted) houses that nest inside each other, and a candy mold of tiny brains. I recovered the houses with scrapbook paper and am creating an activity about making hospital birth more like home, and the candy molds will be tiny soap-reminders for families to use their “BRAIN”s when making birth choices. (Benefits, Risks, Alternatives, Intuition and Not Now.) With Halloween fast approaching, get out there and see what you can find in the seasonal sale bins to make your classes interesting and exciting, and keep your supply budget down.  Remember, making your own supplies doesn’t have to be scary!  It can be economical and a lot of fun.

For complete instructions with pictures, and more DIYs for CBEs, visit me at www.staciebingham.com.

About Stacie Bingham

© Stacie Bingham

© Stacie Bingham

Stacie Bingham, LCCE, CD(DONA), embraces the lighter side of the often weighty subject of birth. Her style feels more like a comedy-show experience than a traditional class. She has been a La Leche League Leader for 13 year, attended 150 births as a doula, and logged 1000 hours as a childbirth educator. An experienced writer and editor, she was a columnist for the Journal of Perinatal Education’s media reviews, has been published in LLLI’s New Beginnings and DONA International’s International Doula, and keeps up with her blog (where she frequently shares her teaching ideas).

She is the current Chair for Visalia Birth Network, and a founding member of Chico Doula Circle, and Advocates for Tongue Tie Education. Stacie has presented at conferences on the topic of tongue tie, as her 4th baby came with strings attached. Stacie and her four sons, husband, and two dogs reside in California’s Central Valley. For more information or teaching tips, visit her at staciebingham.com.

Childbirth Education, Guest Posts, Healthy Birth Practices, Lamaze International, Series: Brilliant Activities for Birth Educators , , , , , , , ,

Time for ACOG and ASA to Change Their Guidelines! Eating and Drinking in Labor Should Not Be Restricted

October 27th, 2015 by avatar

“…The problem for anesthesiologists is that our practice guidelines on obstetric anesthesia are strongly worded, and state that women can not eat during labor. We can’t ethically design a large enough study to answer this question, so we will have to wait for expert opinion to change.” – Paloma Toledo, MD

Screenshot 2015-10-26 17.04.39Social media was all abuzz yesterday about information coming out of the American Society of Anesthesiologists (ASA) conference currently being held in San Diego, CA. Headlines everywhere screamed “Eating During Labor May Not Be So Bad, Study Suggests,” “Light Meal During Labor May Be Safe for Most Women,” and “Eating During Labor Is Actually Fine For Most Women.”  People chortled over the good news and bumped virtual fists over the internet celebrating this information.

The ASA released a press release highlighting a poster being presented at the ASA conference by two Memorial University medical students, Christopher Harty and Erin Sprout. Memorial University is located in St. Johns, Newfoundland, Canada. When a professional conference is being held, several press releases are published every day to advise both professionals and the public about news and information related to the conference. This was one of many released yesterday.

The student researchers suggested in their poster presentation that it may be time for a policy change. Their research indicated that, according to the ASA database, there has only been one case of aspiration during labor and delivery in the period between 2005 and 2013. That aspiration situation occurred in a woman with several other obstetrical complications. “…aspiration today is almost nonexistent, especially in healthy patients,” the researchers stated. The research was extensive – examining 385 studies published since 1990. Much of the research available supported the findings in the poster presentation/study.

The current policy of the ASA on oral intake in labor is that laboring women should avoid solid food in labor. You can read the ASA’s most current guidelines, published in 2007: Practice Guidelines for Obstetric Anesthesia An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.  The American College of Nurse Midwives recommends “that women at low risk for pulmonary aspiration be permitted self-determined intake according to guidelines established by the practice setting.” They also conclude “drinking and eating during labor can provide women with the energy they need and should not be routinely restricted.”  American College of Obstetricians and Gynecologists recommends no solid food for laboring women and refers to the ASA guidelines.

I connected with Paloma Toledo, MD, an obstetrical anesthesiologist who is attending the ASA conference in San Diego to ask her what her thoughts were on this new research. “General anesthesia is becoming increasingly rare, so fewer women are at risk for aspiration, since most women will have neuraxial anesthesia for unplanned cesarean deliveries. The question is, is eating in labor unsafe? They do allow a light meal in the UK, studies have shown that eating does not adversely affect labor outcomes, and in the CEMACE data, despite allowing women to eat in the UK, there have not been deaths related to aspiration. I think a lot of women want to move away from the medicalized childbirth and have a more natural experience. Women want to eat, and I believe the midwife community has been encouraging eating in labor. The problem for anesthesiologists is that our practice guidelines on obstetric anesthesia are strongly worded, and state that women can not eat during labor. We can’t ethically design a large enough study to answer this question, so we will have to wait for expert opinion to change.”

Lamaze International released an infographic in July, 2014 covering this very topic. “No Food, No Drink During Labor? No Way!” and I covered this in a Science & Sensibility post sharing more details.  You can find all the useful infographics available for downloading, sharing and printing here.  Additionally, the fourth Healthy Birth Practice speaks to avoiding routine interventions that are not medically necessary, and it has long been clear that restricting food and drink in labor is certainly an intervention that should not be imposed.

It is important for birth professionals to recognize what the American Society for Anesthesiologists’ press release is and what it is not. We must not overstate the information that they have shared. Please be aware that this is not a policy change.

Hopefully, this will be a call to action by the ASA to examine the contemporary research and determine that that their existing guidelines are outdated and do not serve laboring and birthing people well, nor reflect current research.

Childbirth educators and others can continue to share what the evidence says about the safety and benefit of oral nutrition during labor and encourage families to request best practice from their healthcare providers and if that is not possible, to consider changing to a provider who can support evidence based care.


American College of Nurse-Midwives, (2008). Providing Oral Nutrition to Women in Labor.Journal of Midwifery & Women’s Health53(3), 276-283.

American Society of Anesthesiologists Task Force on Obstetric Anesthesia. (2007). Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.Anesthesiology106(4), 843.

Committee on Obstetric Practice. (2009). ACOG Committee Opinion No. 441: Oral intake during labor. Obstetrics and gynecology114(3), 714.

Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub3.

Childbirth Education, Do No Harm, Evidence Based Medicine, Healthy Birth Practices, Lamaze International, Medical Interventions, Research , , , , , , , ,

Choosing a Pregnancy and Birth Health Care Provider – New Infographic from Lamaze International

October 22nd, 2015 by avatar

Screenshot 2015-10-21 16.44.29Most families have already chosen a health care provider by the time they find themselves in childbirth classes.  The exception might be those educators who reach families at the beginning of their pregnancies by offering an early pregnancy class that includes this topic.  Most families begin their childbirth class experience close to, if not in, the third trimester. By that time, many pregnant people have chosen their pregnancy and birth provider months before.  They made their choice because they received gynecological care from them prior to pregnancy, a particular doctor or midwife was on their medical insurance panel or their friend or family member had used them.  Some families do a lot of research before making this choice, but many families do not.

Screenshot 2015-10-21 16.43.54One of the reasons that I like being an independent childbirth educator who is not affiliated with any particular hospital or facility, is that my students represent a cross section of members from the community, and their care is equally as diverse.  Families will be birthing at home, in a birth center or in a hospital and will be receiving care from licensed midwives, certified nurse midwives, obstetricians and family practice doctors.  And they will all be in the same class.  As we move through the curriculum, the students learn about best practice and evidence based care for normal, healthy low risk pregnant people.  I spend a lot of time building community and offering opportunities for students to work collaboratively on activities during class.  They connect with each other and share their experiences.  They have a chance to learn about the care and recommendations that their classmates are receiving from the variety of providers represented.  This generates wonderful discussions and questions.

This class diversity allows me to facilitate a discussion about evidence based care and best practices.  Families are encouraged to consider if they are satisfied with the care they are receiving, to have conversations with their health care providers about the standard birth practices and determine if their own birth preferences are lined up with the care they are most likely to receive.  If they come to the conclusion that they may not have made the best choice, we explore what their options are.

Lamaze International understands how critical choosing a health care provider is to families who desire a safe and healthy birth.  Their newest infographic provides resources and information to help families understand that selecting a health care provider is an important decision and not one to be taken lightly.  The infographic also explains how the midwifery model of care is often a good choice for healthy, low risk pregnant people.  85% of all pregnant people are considered low risk.  There are conditions that would risk out a person from midwifery care, and should that happen during the prenatal or intrapartum period, the midwife will refer appropriately to a physician.  This helpful infographic discusses the different types of maternity care providers and offers questions to use as a guide when selecting health care providers to work with.

In addition to this infographic, Lamaze International offers a free online early pregnancy class – “Prepared for Pregnancy: Start off Right” that families can work through.  This interactive e-learning course covers important topics that families should be considering and learning about in the first weeks of pregnancy, often before they have even had their first prenatal appointment with their health care provider.  You are invited to try out this course as well, so that you can recommend it to the “just pregnant” families that you connect with.

Screenshot 2015-10-21 16.44.14As a birth professional, you can help families find a health care provider who is a good fit for their desires and preferences.  Helping them to understand what good care looks like, and providing them resources to identify a doctor or midwife who practice style aligns with their wishes can help them achieve a safe and healthy birth.  Letting them know that it is never too late to switch health care providers, even if they are just days away from their birth.  I asked some families to share with me their experiences in switching to a more compatible health care provider during a pregnancy, and here is what they said:

“When we wrote up our birth plan, one provider read through it and condescendingly asked what website we’d downloaded it from and brushed off our concerns – and ours was a very basic birth plan, evidence-based and realistic. After that and another incident a few weeks later involving fetal movement, it was pretty clear that this practice was probably not our best fit.  I managed to get an appointment scheduled with my first choice CNM for 37w 5d. It was such a hard decision, even to get that far! Pregnancy hormones, feeling like I was disrupting or losing established relationships, even fear that the OB would be mad. Fortunately, the CNM was a perfect fit and we all knew it right away. We finished the appointment and immediately signed the paperwork to transfer care and records. Apparently my body and the baby were pleased, as baby was born less than two days later at 38 weeks exactly. We ended up having exactly the birth we wanted.” – ZV


“I changed providers in my third trimester. The constraints of the birth location were slowly whittling away at the family and doula support I anticipated needing. I opted for a licensed midwife who helped me birth at home, surrounded by the caring loved ones who helped make the experience safe and satisfying. It wasn’t an easy choice, and we had to pay more, but the feelings and memories from that day I will always treasure.I know it was the right choice for our family.” – SB


“I switched from an OB to midwifery care after an early miscarriage. I was upset and my ob said, “let’s just keep this in perspective”. My perspective was that I needed a new care provider! – CM


“I switched providers at 8 weeks. My OB said her office does not do VBACs. So I found another practice who did – and it happened to be with a midwife. I didn’t think I was the midwife type but I really wanted a VBAC.  And I had a great one!” – SW


“For my second child, I had originally gone back to the same OB I used during my first pregnancy (and subsequent miscarriage). I hadn’t been entirely happy with the way I had been treated the first go-round, but I was familiar with him and liked the hospital he delivered at.  Just after my 19 week ultrasound, however, I finally got tired of being ignored and belittled during my appointments. I scheduled an appointment with a midwife at a nearby birth center, took a tour, and never looked back. Being cared for by midwives was the best decision I have ever made…At the birth center, I never felt like I was just another file. They knew me, knew my family, and took the time to make sure I was getting my questions answered and my concerns were addressed immediately – I was never made to feel stupid for anything I said or asked about. My birth experience was 100 times better. Switching at 21 weeks pregnant was, no question, the best thing I could have done.”- JD


“I switched providers at 34 weeks. I switched for a few reasons, but mostly the midwifery practice seemed very standardized and cold not as personal as the practice I delivered with previously. I made the decision to switch, saw my new midwifery group only twice and delivered at 37w4d. I was very pleased with my experience with the new practice.” – TNM


“I switched providers two times during my pregnancy. I had an unusual health history and wanted a birth with the least interventions possible. Despite being upfront about my history with everyone I spoke with, I kept losing practitioners who felt I was too high risk to them to care for. I felt my birthing goals slipping further and further away every time this happened. It was only after I realized I was spending every single appointment crying that I decided that I needed to let some things go. I made my final switch, choosing my family practice doctor who also did babies. I realized that the most important thing was to have a good relationship with a provider I trusted, who respected my goals, and who didn’t have me in tears after every appointment. This change meant I had to change the hospital I chose to birth at to the one in the area with the highest rate of interventions, but I could not spend the remainder of my pregnancy under such extreme stress. Less interventions would be best for my son, but having a mother who wasn’t feeling threatened at every turn would help as well. I get tearful now, over eight years later, writing about it. In the end, I did get the interventions I didn’t want, but only after my provider let me push it as far as possible. She respected my goals. It was the right choice but incredibly challenging to face having to change and losing trust over and over. I felt abandoned by too many people at a time when I was very vulnerable.” – SD

Birth professionals can find all the useful infographics here and share the parent infographics page with the families you work with. Parents can find the new infographic on choosing a provider here on the parent website.  Choosing a care provider is an important part of having a safe and satisfying birth experience.  Childbirth educators and professionals are in a unique position to support families as they navigate their choices and make decisions that can help them reach their goal of a healthy and safe birth, baby and parent.  For a very detailed guide to questions to ask a care provider, I find the Choices in Childbirth National Guide to a Healthy Birth to have a very comprehensive list of questions for families to rely on.  The list can be found on page 10 of this brochure.

Lamaze International continues to support professionals and educators with infographics and tools to help families navigate their pregnancy and birth and work toward healthy outcomes.  This new infographic on “Choosing a Care Provider” is another excellent tool that is available for you and consumers.  Thanks Lamaze!


Childbirth Education, Lamaze International, Maternity Care, Midwifery, Push for Your Baby , , , , ,

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