Vaginal Birth After Cesarean Section

With the cesarean section rate approaching 33% in the United States (meaning that one out of every three women will undergo a cesarean section), interest is re surging in the VBAC (vaginal birth after cesarean section). The American Congress of Obstetricians and Gynecologists recently updated their guidelines encouraging women that are candidates for a trial of labor to consider VBAC. In the late 1970s through the 1980s, VBACs were very popular. Previously, the idea persisted that "once a cesarean section, always a cesarean" led practitioners to steer away from trials of labor and recommend repeat cesarean section. However, as more data accumulated regarding the success of VBAC, greater amounts of physicians began to offer this as an option to women.

As more women began to VBAC case reports of uterine rupture began to increase, which lead to a subsequent decrease in the rates of trials of labor after cesarean section and VBACs. Much of this decrease was driven by malpractice and litigation concerns. Admittedly, a patient hearing the words "uterine rupture" can be enough to make a woman jump on the OR table and offer to perform the c-section herself. However, before you decide that a VBAC isn't for you, there are several things you should know. First, while the risk of uterine rupture exists, the risk is only 0.5% of one previous cesarean section! Think of it like this. You have a 1 in 77 chance of dying in some sort of transportation incident in the next year, yet you still drive, take a bus, ride a train, or fly regularly done you? You have a 0.4% chance of dying from a fall in the shower, yet you shower (hopefully) daily. So yes, VBAC isn't risk free, but neither is a repeat cesarean section. Complications include bleeding, infection, injury to internal organs. Before jumping on the table, you might want to consider other options. Plus, your recovery is much faster after a vaginal delivery compared to a cesarean section. Finally, if you are planning on having a large family it behooves you to consider VBAC as the incidence of complications increases as the number of previous cesarean section increases.

Who are the ideal candidates? If you have had a previous vaginal delivery, a previous c-section for breech presentation or in an emergency, or a previous VBAC then you should ask your practitioner today!!! Regardless, you should consult with your OBGYN regarding if VBAC is right for you. Remember, PUSH! While labor is tough (after all it ain't called labor for nothing!), the benefits of VBAC are endless and should be considered!

Breastfeeding Survival 101

Survival???  Sounds a bit dramatic?  That's because for many women, the first few weeks of their infant's life is spent trying to get the hang of nursing their little one.  For those newborns who latch on right away, count your blessings.  For those who find it challenging, hopefully the information in this article will help you stick with it.  It does get easier!  If you can hang in there for the first couple of weeks, you and your infant will become a professional nursing unit in no time!

1) Breathe!  You can do it!  Breast milk is the most natural and loving source of nutrition that you can provide for your infant.  YOU CAN DO IT!

2) Find your hospital's lactation consultant.  Prior to delivery, contact your planned delivery hospital and speak with them regarding nursing support.  You can ask if they have any suggestions or if any courses are offered for expecting mothers.  Similarly, you may contact your area La Leche League, which provides nursing support for expecting and new mothers.

3)  At birth, if your infant does not need to be transported to the warmer for a medical reason, request that your baby be placed onto your skin.  Skin to skin warming helps promote bonding between mother and child and it prepares baby for his/her first feeding.

4) Attempt to nurse your baby within the first hour of delivery.  Ask your nurse for tips regarding latching on.  The baby's mouth should be over your areola to facilitate proper placement of the nipple into your infant's mouh.  Do not simply place only the nipple into the baby's mouth as this will eventually leave you with very sore nipples.  While the initial first suckles might be a little uncomfortable, the discomfort should disappear after that and the majority of the nursing session should NOT be uncomfortable.  Pain lasting more than the first minute of feeding indicates an improper latch.

5)  Pain medications used during and after labor can make your baby drowsy initially.  You may have to stimulate or irritate your intant initially to feed.  Newborns need to feed every two hours (every three hours at most) during the first few weeks of life.  However, don't be shocked if your infant feeds more frequently than this.  Ask your pediatrician for signs that your baby is getting enough milk (typically 6-8 wet diapers a day by day 3).

6) Colostrum is a form of milk!  You can rest assured that your Infant is receiving food by the appearance of their stool.  Right after birth, the first few stools will be dark brown (called meconium).  As your infant takes in your milk, the color and consistency changes to a seedy yellow color.

7) Avoid giving your infant a pacifier for the first month of life as it may interfere with feeding cues. Likewise, avoid giving your infant formula during the first month unless instructed to by your physician as this can interfere with establishing milk production. Introducing bottles too early can lead to "nipple confusion", causing the baby to reject the breast.

8) Breastfeeding initially can be exhausting.  Have your spouse/significant other/support person make night time feedings easier on you by having them change the baby's diaper and bring him or her to you in bed at night to make feeding more comfortable during the wee hours of the morning.

9) At the end of feedings, allow your breast milk to air dry on your nipples as this will provide natural moisture and help to prevent chapped nipples.  If you need more moisture, you can purchase Lansinoh cream to place on your nipples at the end of feedings. If you feel that your nipples are too sore to nurse, you can purchase a nipple shield to place over your nipple while feeding until they heal. This will allow you to continue to nurse and maintian milk supply.

10) Initially offer both breasts to your infant during feeding.  Once your milk supply is well established you can alternate, however, remember that you will need to make sure to utilize both regularly to keep your milk supply up.

11) Nursing pads for bras are essential.  Place these into your bras when you are out and about to prevent milk from leaking onto your clothes.

12). Remember,  you can do this!  If you make it past the first two weeks, you are good to go!  Don't feel guilty if you are frustrated!  Keep trying!  Tears are not unusual for both you and your Infant, but rest assured that many successful nursing mothers have felt like this.  The feeling is only temporary!!!!