Welcome! If you are planning a c-section or wanting to have a Vaginal Birth After a Cesarean (VBAC), there are options in Nashville for you.
If you are planning a cesarean, find a doctor who does them all the time. Also, learn about what happens during a c-section and afterwards. It is hard to make an informed decision without knowing your options. Did you know that Nashville hospitals offer family centered cesareans? Does your doctor do single or double suturing? I would also suggest that you visit ICAN of Nashville. They have all the up to date information.
If you are planning a VBAC, vaginal birth after a cesarean, don't give up hope. It is possible! With a little work and advice from others, you can find the doctor and hospital for you. I have listed a few tips to help you be more successful.
1. Visit ICAN of Nashville http://icanofnashville.webs.com/. Local moms and ICAN leaders meet monthly teaching many different topics to support moms who had c-sections or who want to VBAC. You will love the acceptance you receive from them. They also know all the current doctors who support VBACs, VBA2C, etc.
2. Visit Vaginal Birth After Cesarean Checklist http://www.childbirth.org/section/VBAC.html
3. "VBAC.com provides childbearing women and maternity care professionals access to evidence-based resources, educational materials, and support for VBAC and cesarean prevention. "
4. You might want to consider taking a VBAC preparation class. Second Heartbeat Childbirth Education is taught by Ann Marie Walsh Costs: $75 (3 sessions)
NOVA Birth Services VBAC class Costs:$150 (2 two hour sessions)
5. Find a supportive doctor. If you want a c-section, find a doctor who does them all the time. If you want a VBAC, find a doctor who supports that. Call and ask their success rate. A word of caution. Some doctors tell you they will support a VBAC and then at 38 weeks tell you to schedule your c-section. This is called Bait and switch. You are not without choices. Please call ICAN or a doula for help. You can change providers or at least get a second opinion. Know the difference between VBAC tolerant and VBAC friendly Dr's.
VBAC Friendly Care Providers:
Women's OB has midwives and OB's who support VBAC's (Centenniel & St. Thomas)
Dr Thigpen (Vanderbilt)
Vanderbilt Midwives at Melrose Place (Vanderbilt) no VBA2C
Dr. John Link and Dr. SueAnn McGuire (Summit)
Dr. Riggan and Dr. Nancy Bradbury (Hendersonville)
Dr. Michael Nobles (Murfreesboro)
the Farm Midwives (home birth)
Jennifer Vines, Mary Anne Richardson, Sheryl Shafer, Talitha Mills, Kathy Williams,, Daphne McIntosh (Homebirth Midwives)
6. You will want to massage your C-section scar before your VBAC. Click here to print off an instructional sheet on how to do this.
7. Get your post operation report to find out if your incision was double sutured or single sutured. Contact your careprovider or hospital to request a copy of your record.
8. Hire a doula who has worked with VBACs successfully.
9. Find out the statistics in the hospital where you want to deliver. Do they support VBACs or ban them. You can see the latest rates by visiting the Hospitals page.
10. Read and educate yourself. It is hard to make an informed decision when you do not know what the options are.
Articles to read:
Making a Mountain out of a Molehill
Myth: Risk of uterine rupture doesn't change much after a cesarean.
OB/GYNS Issue Less Restrictive VBAC Guidelines
Open Season: A Survival Guide for Natural Childbirth and VBAC in the 90s by Nancy Wainer Cohen
VBAC Companion: The Expectant Mother's Guide to Vaginal Birth After Cesarean by Diana Korte
Silent Knife: Cesarean Prevention and Vaginal Birth after Cesarean by Nancy Wainer Cohen & Lois Estne
Expectant Parent’s Guide to Preventing a Cesarean Section by Carl Jones
Understanding the Dangers of Cesarean Birth: Making Informed Decisions by Nicette Jukelevics
Natural Childbirth After Cesarean: A Practical Guide by Karis Crawford
11. See a pelvic floor specialist. They can help make sure that all the muscles and ligaments are in alignment for a smooth pregnancy and birth.
Click here to download a pdf of these tips
Many woman have past trauma. There are groups that can help you heal.
ACA WSO http://www.adultchildren.org/ Go to this website to find when group meetings are held. The meetings are free and held all over the country. This group is a safe place to share feelings and learn about your true self. You will learn to cleanse negative habits, heal from negative thoughts, and love the true you.
Solace For Mothers "an organization designed for the sole purpose of providing and creating support for women who have experienced childbirth as traumatic. Birth Trauma is real and can result from even a seemingly "normal" birth experience."Solace for Mothers Healing After Traumatic Childbirth
Momma Trauma blog
Prevention and Treatment of Traumatic Childbirth http://pattch.org/
WISH (Woman's Institute for Sexual Health) "Brooke Faught NP at WISH women's institute for sexual health in Nashville. She can do a thorough eval and give a woman specific PT for her exact issue."
Patricia Dean (615) 438-3132 (Brentwood area) www.makepositivechanges.net
The American Congress of Obstetricians and Gynecologists (ACOG) issued a practice bulletin in 2010, specifically addressing research about trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC). The old saying, “once a cesarean always a cesarean” no longer holds true. For many women who have had one prior cesarean or even two, they can attempt a TOLAC to achieve a vaginal birth.
A woman who is able to have a VBAC has fewer complications including: avoiding major abdominal surgery which results in shorter recovery period and lower rates of hemorrhage and infection.
For women who may desire larger families, a VBAC may avoid future problems of multiple cesareans such as bowel or bladder injury, hysterectomy, infection, transfusion and issues with the placenta, such as placenta accreta and placenta previa.
There appears to be little difference in findings among women who have a low-transverse uterine incision and women who have low vertical incisions or unknown types of uterine incisions.
A classical, vertical incision or a T incision have the highest probability for uterine rupture.
The most common risk factor associated with a TOLAC is the risk of uterine rupture. The chance of a rupture for women with one prior cesarean delivery is less than one percent (0.7-0.9 percent chance). For women with two cesarean deliveries the chance of a uterine rupture is 0.9-1.8 percent.
Augmenting labor has been shown to decrease VBAC success rates, but is not contraindicated for TOLAC patients.
It is recommended that misoprostol (cytotec) not be used in TOLAC patients, as it has been shown to increase chances for uterine rupture.
Factors to consider:
ACOG also states in its Practice Bulletin (2010) that “it is reasonable to consider women with two previous low transverse cesarean deliveries to be candidates for TOLAC, and to counsel them based on the combination of other factors that affect their probability of achieving a successful VBAC.”
Several factors can negatively impact the likelihood of achieving a VBAC, but should not be reasons to deny a TOLAC to a patient:
Big baby (macrosomia)
A pregnancy that goes beyond 40 weeks
Short length of time between pregnancies (You want 18 months between deliveries)
Increased maternal age
Counseling Patients about TOLAC
Considering a TOLAC is an on-going process that providers and patients must engage in together. Each patient has a specific set of circumstances that need to be taken into consideration for a TOLAC. If any new problems/issues arise during the pregnancy, the decision to attempt a TOLAC should be re-evaluated to minimize risk to mother and baby, but a patient’s autonomy needs to be respected in the decision-making process.
Providers need to counsel patients on the benefits and risks of TOLAC and allow the PATIENT to make the decision regarding TOLAC.
ACOG clearly states that “Respect for patient autonomy supports the concept that patients should be allowed to accept increased levels of risk, however, patients should be clearly informed of such potential increase in risk and management alternatives.”
For additional support, refer patients to the International Cesarean Awareness Network (ICAN). There is a chapter here in the Nashville area.
American Congress of Obstetricians and Gynecologists (August, 2010). Practice Bulletin – Vaginal birth after previous cesarean; Number 115. http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Obstetrics/Vaginal-Birth-After-Previous-Cesarean-Delivery