When you are the statistic: Uterine rupture loss

When you are the statistic: Uterine rupture loss

Above: “I donated my wedding dress to be made into gowns for deceased infants to be buried in. I had pictures done in my dress before I donated it. This is one of my favorites.” – Kaila Flory

Kaila Flory lost her baby to a uterine rupture eight months ago. She recently reached out to me and gave me permission to share her story and pictures of her son Beau.  She is currently raising money to purchase Cuddle Cots in Beau’s memory. Cuddle Cots are refrigerated bassinets that enable loss parents to spend more time with their child. While t-shirt sales end on April 22, 2016 at midnight EST, you can donate anytime. Even just $10 will get her closer to her goal. Buy a t-shirt and/or donate here.  Connect with her Facebook page here

Women who have had uterine ruptures and lost their babies have endured some of our greatest fears. But they are part of our community as well. When the VBAC Facts Community, a Facebook group, was opened to the public, we welcomed and embraced the parents who joined us after their loss. Often they felt like they were no longer part of the birth community. They didn’t know where they fit in. They felt isolated and yet they wanted to share their story. We had many loss moms as members and many parents who were planning VBACs who wanted to hear their stories.

What follows is Kaila’s story.

Kaila Flory’s first son was born by cesarean after being induced for intrauterine growth restriction. When she was 38 weeks and a few days pregnant with her second son, 26-year-old Kaila started having cramps around 1 a.m. “Luckily I had stayed with my dad, so I was not alone with my 3 year old. My husband was at Basic Training. Then a contraction came. Ok, I thought, this is real. It’s time. Then another came. It had only been like a minute or 2. Then severe pain came over my abdomen, and my face and limbs went numb.”

Her father called the paramedics and she was rushed to the hospital, where a STAT c-section was ordered. She nearly bled to death.

Beau-&-Kaila

“This is the only photo I have of myself holding him. I requested people to not take my photo, but I am so glad my best friend took this with her phone. THIS is what raw, real pain looks like. This is why I want people to have Infant Loss Awareness.”

She says:

While I wholeheartedly believe that women should be given the option for VBACs, I also believe women need to consider their child’s health as the most important in this situation. I would have loved to have 3 weeks of pain just to have my son in my arms. I know it is not my fault, and that they do not, normally, schedule a c-section until 39 weeks, but part of me still feels guilty.

When Kaila contacted me, my heart broke. I emailed her back:

Kaila,

Thank you so much for sharing your story with me and I am so sorry about your loss.

I want you to know that I hear you. I really hear you.

I talk quite a bit about how these small numbers represent real women and real babies and it doesn’t matter how small the risk is, if it happens to you, if you are that number, it’s devastating.

The difficulty is that there are serious risks both ways. With VBAC, we have uterine rupture. With repeat cesareans, we have accreta.

Accreta results in more maternal deaths, more maternal complications and comparable infant deaths and complications to uterine rupture. Accreta requires a more sophisticated response of which many hospitals are unable to offer which results in more deaths and complications. Many women are never told about the risks of accreta which prohibits them from making an informed decision. [View my sources and read more about accreta here.]

I discuss uterine rupture and accreta extensively in my workshops including how often it happens, variables that can impact the rate, and outcomes for mother and baby because there is so much confusion about where the risk lies and what could happen.

The other difficulty is that no one can predict how an individual birth will play out. Will you be the one to have a uterine rupture? An accreta? And in either of these situations, will you be the one to lose your baby? Or will you have a safe VBAC or repeat cesarean with a healthy mom and baby? There are no guarantees in life and no crystal balls.

Some women who lose their babies to uterine rupture say, “Don’t plan VBACs.”

Some women who lose their babies to accreta say, “I wish I had access to VBAC.”

So the question is, if there are serious complications either way, who should make the decision on how to birth?

It always comes down to the mother.

Given the small chance of a bad outcome, women should have the option to decide what set of risks and benefits are tolerable to them. They should not be forced into cesareans or mislead into VBACs. This needs to be their decision based on information. Part of the reason why I started VBAC Facts is that I, as a consumer, wanted more information and it wasn’t easy for me to find.

To bring it full circle, I hear you.

Have you had the opportunity to connect with other loss moms? I have compiled a resource page here.

I know it may ring hollow, but you are not to blame. Sometimes things happen that we cannot predict and that are outside of our control and I’m so very sorry you were the statistic.

I’ll keep you in my heart Kaila. <3

Warmly,

 

Jen

Kaila replied:

I will be honest with you, my doctor did not mention accreta once. Wow that is scary too. 🙁 I don’t wish that or a rupture on anyone. Thank you so much for responding to me. And thank you for advising women on what to do after a C-section. If you ever want to use my story, please let me know. I would be happy to share it for statistic purposes. Thanks so much! 🙂

So I’m sharing Kaila’s story today. As I said in my email to her, I talk about the risks of uterine rupture and accreta in my workshops because they are both real risks on either side of the equation. Sadly, a small number of people will experience this reality, and they deserve our support and compassion.

I do hope you will support Kaila’s Cuddle Cots fundraiser. Even just $10 will get her closer to her goal. Donate here. Connect with her Facebook page here.

Learn more about Infant Loss Awareness here.

What do you think?
Leave a comment.

What do you think? Leave a comment.

Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

Learn more >

Free Report Reveals...

Parents pregnant after a cesarean face so much misinformation about VBAC. As a result, many who are good VBAC candidates are coerced into repeat cesareans. This free report provides quick clarity on 5 uterine rupture myths so you can tell fact from fiction and avoid the bait & switch.

VBAC Facts does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts and you should consult a qualified health care professional in all matters relating to your health. Created By: Jen Kamel | Copyright 2017 VBAC Facts | Terms of Use | Privacy Policy

 

Above: “I donated my wedding dress to be made into gowns for deceased infants to be buried in. I had pictures done in my dress before I donated it. This is one of my favorites.” – Kaila Flory

Kaila Flory lost her baby to a uterine rupture eight months ago. She recently reached out to me and gave me permission to share her story and pictures of her son Beau.  She is currently raising money to purchase Cuddle Cots in Beau’s memory. Cuddle Cots are refrigerated bassinets that enable loss parents to spend more time with their child. While t-shirt sales end on April 22, 2016 at midnight EST, you can donate anytime. Even just $10 will get her closer to her goal. Buy a t-shirt and/or donate here.  Connect with her Facebook page here

Women who have had uterine ruptures and lost their babies have endured some of our greatest fears. But they are part of our community as well. When the VBAC Facts Community, a Facebook group, was open to the public, we welcomed and embraced the parents who joined us after their loss. Often they felt like they were no longer part of the birth community. They didn’t know where they fit in. They felt isolated and yet they wanted to share their story. We had many loss moms as members and many parents who were planning VBACs wanted to hear their stories.

What follows is Kaila’s story.

Kaila’s Flory’s first son was born by cesarean after being induced for intrauterine growth restriction. When she was 38 weeks and a few days pregnant with her second son, 26-year-old Kaila started having cramps around 1 a.m. “Luckily I had stayed with my dad, so I was not alone with my 3 year old. My husband was at Basic Training. Then a contraction came. Ok, I thought, this is real. It’s time. Then another came. It had only been like a minute or 2. Then severe pain came over my abdomen, and my face and limbs went numb.”

Her father called the paramedics and she was rushed to the hospital, where a STAT c-section was ordered. She nearly bled to death.

Beau-&-Kaila

“This is the only photo I have of myself holding him. I requested people to not take my photo, but I am so glad my best friend took this with her phone. THIS is what raw, real pain looks like. This is why I want people to have Infant Loss Awareness.”

She says:

While I wholeheartedly believe that women should be given the option for VBACs, I also believe women need to consider their child’s health as the most important in this situation. I would have loved to have 3 weeks of pain just to have my son in my arms. I know it is not my fault, and that they do not, normally, schedule a c-section until 39 weeks, but part of me still feels guilty.

When Kaila contacted me, my heart broke. I emailed her back:

Kaila,

Thank you so much for sharing your story with me and I am so sorry about your loss.

I want you to know that I hear you. I really hear you.

I talk quite a bit about how these small numbers represent real women and real babies and it doesn’t matter how small the risk is, if it happens to you, if you are that number, it’s devastating.

The difficulty is that there are serious risks both ways. With VBAC, we have uterine rupture. With repeat cesareans, we have accreta.

Accreta results in more maternal deaths, more maternal complications and comparable infant deaths and complications to uterine rupture. Accreta requires a more sophisticated response of which many hospitals are unable to offer which results in more deaths and complications. Many women are never told about the risks of accreta which prohibits them from making an informed decision. [View my sources and read more about accreta here.]

I discuss uterine rupture and accreta extensively in my workshops including how often it happens, variables that can impact the rate, and outcomes for mother and baby because there is so much confusion about where the risk lies and what could happen.

The other difficulty is that no can predict how an individual birth will play out. Will you be the one to have a uterine rupture? An accreta? And in either of these situations, will you be the one to lose your baby? Or will you have a safe VBAC or repeat cesarean with a healthy mom and baby? There are no guarantees in life and no crystal balls.

Some women who lose their babies to uterine rupture say, “Don’t plan VBACs.”

Some women who lose their babies to accreta say, “I wish I had access to VBAC.”

So the question is, if there are serious complications either way, who should make the decision on how to birth?

It always comes down to the mother.

Given the small chance of a bad outcome, women should have the option to decide what set of risks and benefits are tolerable to them. They should not be forced into cesareans or mislead into VBACs. This needs to be their decision based on information. Part of the reason why I started VBAC Facts is that I, as a consumer, wanted more information and it wasn’t easy for me to find.

To bring it full circle, I hear you.

Have you had the opportunity to connect with other loss moms? I have compiled a resource page here.

I know it may ring hollow, but you are not to blame. Sometimes things happen that we cannot predict and that are outside of our control and I’m so very sorry you were the statistic.

I’ll keep you in my heart Kaila. <3

Warmly,

Jen

Kaila replied:

I will be honest with you, my doctor did not mention accreta once. Wow that is scary too. 🙁 I don’t wish that or a rupture on anyone. Thank you so much for responding to me. And thank you for advising women on what to do after a C-section. If you ever want to use my story, please let me know. I would be happy to share it for statistic purposes. Thanks so much! 🙂

So I’m sharing Kaila’s story today. As I said in my email to her, I talk about the risks of uterine rupture and accreta in my workshops because they are both real risks on either side of the equation. Sadly, a small number of people will experience this reality, and they deserve our support and compassion.

I do hope you will support Kaila’s Cuddle Cots fundraiser. Even just $10 will get her closer to her goal. Donate here. Connect with her Facebook page here.

Learn more about Infant Loss Awareness here.

What do you think? Leave a comment.

Free Report Reveals...

Parents pregnant after a cesarean face so much misinformation about VBAC. As a result, many who are good VBAC candidates are coerced into repeat cesareans. This free report provides quick clarity on 5 uterine rupture myths so you can tell fact from fiction. DOWNLOAD NOW

VBAC Facts does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts and you should consult a qualified health care professional in all matters relating to your health. Created By: Jen Kamel | Copyright 2017 VBAC Facts | Terms of Use | Privacy Policy

 

Resources for processing traumatic births and losses

Resources for processing traumatic births and losses

A dear woman contacted me.  15 months after her cesarean, it was still hard for her to read my posts without crying.  This simply broke my heart.  She is not alone.  There are many women who carry the grief and pain of their traumatic vaginal or cesarean births or the loss of their baby.  Every. Day.

So I asked on Facebook for resources for women who are in the midst of the processing and grieving.  Here is the list.  If you know of more, whether they are on-line or in-person groups, for free or a fee, please leave a comment.

None of these groups or individuals have been checked out or endorsed by VBAC Facts.  This is simply a list of resources for you to check out.

It saddens me to say this but there are individuals and groups who find and share the stories of loss moms in order to berate them.  Please be careful when sharing information on the internet as anything you post on-line can be easily shared with others outside your closed/private internet group.  There is no such thing as privacy on the internet.  Being anonymous and not providing your home address or identifying information are ways to get around this.

_____________________

Stillbirthday has a comprehensive list of immediate resources (like crisis hotlines, books, and websites) and long term resources (like workshops and retreats.)

Solace for Mothers

Barbara-ann Horner: I volunteer for Postpartum Support International and most moms who call experience a traumatic birth message me i can find more resources or chat if you’d like

ICAN, the International Cesarean Awareness Network, is awesome. You can go to their website ican-online.org and there’s a ton of info and local support groups to join. I joined one after experiencing a very traumatic cesarean section and it’s been so helpful in the healing process.

The Dunamas Center does a lot of work with birth trauma.

http://www.humanizebirth.org/ has some resources and you can contact the ladies running the page and have our story added to the campaign as well, there is also a facebook page and group for women to share their stories and talk to others who have been through traumatic birth events as well

BEBA clinic (Ray Castelino)

Babycenter has a “Disappointing Birth Experiences” board….

Online, I recently found the Birth Trauma Association. They’re wonderful! They also have a group on Facebook.

I know Nancy Wainer offers group workshops in the Massachusetts  area. Janel Mirendah also works in group or individually on birth trauma, she did a workshop when she came to do a screening of The Other Side of the Glass.

@backline is a great resource. They have a free talkline for birth or miscarriage trauma.

Birthing From Within Birth Story. Listening is amazing.

Birthtalk in Australia!!! They do free group sessions in Australia (Queensland) & personal sessions (also via Skype for international). They are the best

There’s a Birth Crisis group, as well as a CBAC group out there, I know both those group owners and they work hard to keep it safe.

A lady I know who had a stillbirth at 36 weeks is on a site called www.facesofloss.com. “Faces of Loss, Faces of Hope: Putting a face on miscarriage, stillbirth and infant loss.”

Geneviève Prono: I have been helping women heal from a traumatic and difficult birth and prepare for another birth, for twenty years. I do in person and group sessions by skype and am currently writing a book and putting some programs in place. The site in French (apparently google translates it) www.chrysalidefrance.com. What brought me to this three c-sections followed by three VBACs.

Tiffany Hoffman: I do individual birth trauma resolution as well as those who have had difficult or disappointing birth experiences. I have also created a birth trauma workshop, so that women who don’t live here can travel for a weekend intensive to start the healing process. They also learn several ways to continue processing their experience and feelings on their own. My website is www.sacredbirthspace.com

Linda Llone Hinchliffe: Our Birth Choices group offer emotional support to anyone who needs it…

Birth Matters of Fort Wayne, IN offers a Traumatic Birth Healing/Healing for Birth class several times a year. From personal experience – it’s just what my husband and I needed.

There’s a group in Virginia called Mothers Healing Together.

Lexi Abeln: I facilitate a free support group in Camp Hill, PA called Birthlight.

Birth after Caesarean Support and Information Group in Townsville, Queensland, Australia

Canaustralia.net — Empowering birthing women to make informed decisions about childbirth after caesarean

There’s a yoga studio local to me in Pittsburgh, PA that does a traumatic birth workshop.

Precious sleeping angles – group on Facebook

Stillbirth support – group on Facebook

Resources for men

Grieving fathers – group on Facebook

You can also follow the thread I posted on my Facebook page about this for more information or to contact the individuals above who offer counseling.

 

Do you have a resource you would like to add to the list? Please include it in the comments.

What do you think?
Leave a comment.

What do you think? Leave a comment.

Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

Learn more >

Free Report Reveals...

Parents pregnant after a cesarean face so much misinformation about VBAC. As a result, many who are good VBAC candidates are coerced into repeat cesareans. This free report provides quick clarity on 5 uterine rupture myths so you can tell fact from fiction and avoid the bait & switch.

VBAC Facts does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts and you should consult a qualified health care professional in all matters relating to your health. Created By: Jen Kamel | Copyright 2017 VBAC Facts | Terms of Use | Privacy Policy

 

A father says, “Why invite the risk of VBAC?”

A father says, “Why invite the risk of VBAC?”

I recently had an exchange with a father that I wanted to share because I think he has the same concerns as many other parents.

He first left a comment in response to the article I’m pregnant and want a VBAC, what do I do?

Make sure they have a surgical team ready to go 24-7 If you are attempting VBAC’S.

They have about 15 min’s to get the child out, without serious damage after complete uterine rupture. It won’t be a Bikini cut either.

I replied:

Anthony,

VBACs can absolutely be offered safely without 24/7 anesthesia present.  I had the opportunity to attend the March 2010 National Institutes of Health VBAC Conference where the ability of rural hospitals to safely attend VBACs was extensively discussed. One doctor spoke during the public comment period and stated that her rural hospital had a VBAC rate of over 30%! It turns out, if a hospital is supportive of VBAC and motivated, they can absolutely offer VBAC safely. (I also welcome you to read the commentary of two obstetricians and one certified nurse midwife who argued against the VBAC ban instated at their local rural hospital.) Read more about the policies that this hospital implemented: VBAC Ban Rationale is Irrational.

One large VBAC study found that while the risk of infant death or oxygen deprivation in VBACs was 0.05%, the maternal mortality in repeat cesareans was 0.04% (Landon, 2004). Whose lives do we save? And in fact Henci Goer’s analysis shares with us that the 0.05% rate is inaccurately elevated. In the Landon (2004) study, women whose babies had died before labor were encouraged to VBAC. Those infant deaths were included in the 0.05% figure even though their deaths could not be attributed to a labor after cesarean.

There was an entire lecture at the 2010 National Institutes of Health VBAC Conference about uterine rupture, oxygen deprivation and blood gases. You can find a summary in the Program and Abstracts.

Warmly,

Jen

Then he left a comment in response to the article A letter from a hospital explaining why they banned VBAC:

Well written letter by the physician. VBAC’s are very risky. I’ve lived through the personal horror of a catastrophe. And trust me it was catastrophic. I nearly lost my wife and full term son. My son now lives his life as a quadriplegic with Cerebral Palsy. You can’t convince me it’s worth the risk. Not for the child, not for the mother, not for the family, and not for the doctor and hospital.

Greedy insurance companies thought they could turn profits by forcing VBAC’s on mothers. The doctor’s letter is true to form and his statistics are on the money. If you care about people, mothers, babies, and family, “Don’t push for VBAC’S” do the opposite.

To which I replied:

Anthony,

I am so sorry about your son.  To describe what happened to your son as tragic is a drastic understatement.

I agree that the policies in place during the 90s when insurance companies were pushing VBAC were entirely unsafe. VBAC became required in some places and some women were not given a choice about whether or not to VBAC. This resulted in women with contra-indications to VBAC experiencing bad outcomes. Women in crowded hospitals did not receive good care and had bad outcomes. Women desiring trials of labor after cesareans were induced and had bad outcomes. And all of this resulted in VBAC getting a bad name. “Instead of blaming the overuse of induction, mandatory VBACs regardless of suitability, and mismanagement of labor, doctors began saying that it was actually VBAC that was unsafe.” You can read more on the history of VBAC here.

Fortunately, we know more now about the risks and benefits of VBAC and repeat cesareans than we did in the 90s. Like how rupture rates vary depending on the scar type (Landon, 2004), how the risks of cesareans increase with each surgery (Silver, 2006) and the risk of uterine rupture and other complications decrease after the first VBAC (Mercer, 2008). We know now that inducing increases the risk of uterine rupture (Landon, 2004), but that it is a reasonable option when there is a medical indication.  As the Guise 2010 Evidence Reports asserts,

“While rare for both TOL [trial of labor after cesarean] and ERCD [elective repeat cesarean delivery], maternal mortality was significantly increased for ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOL. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between TOL and ERCD. The rate of uterine rupture for all women with prior cesarean is 3 per 1,000 and the risk was significantly increased with TOL (4.7 1,000 versus 0.3 1,000 ERCD). Six percent of uterine ruptures were associated with perinatal death. Perinatal mortality was significantly increased for TOL at 1.3 per 1,000 versus 0.5 per 1,000 for ERCD… VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans.”

So neither option is inherently safe or risky. Both offer a different set of risks. I think it’s important for women to understand these risks when considering their options. I wrote a summary here: Nervous About Planning a VBAC.

Once again, I’m so sorry about your son and I thank you for taking the time to leave your comment.

Warmly,

Jen

To which he replied:

Your statistics mean is nowhere near the mean quoted in the doctors letter. This doctor has performed how many births? and participated in many more. He travels around the country lecturing on this subject? His mean is 2.5% not .05%. .05% is risky too. But I believe 2.5% is more likely for for complications with VBAC.

Accidental death from cesarean he pegs at .001%. That’s .00001

To which I replied:

Anthony,

His statistics are wrong. That is why I posted the letter. I wanted to illustrate how important it is to educate yourself because some OBs just don’t know and give incorrect information either because they don’t know any better or because they are actively skewing their information.  Please read my comment on the differences between an OB’s opinion and medical research.

There is not one large study on VBAC that shows a fetal mortality rate of 1 in 200 (0.5%.) Please check out my bibliography. I’ve read all these studies. If you can find a study on VBAC including over 5,000 women, controlling for scar type, induction method and dose that shows an infant mortality rate of 0.5%, I would love to see it.

Warmly,

Jen

To which he replied:

I still agree with the doctor’s letter above. Why invite the risk? and it is way way too risky. How could the liability limits of a midwife, or small hospital possibly cover such a tragedy? Should that be handled by malpractice reform? By allowing our health professionals to be unaccountable? Recovery for even economic loss is nearly impossible today. The liability is tremendous. Childbirth is already risky enough. I agree that induction may be a contributing factor and maybe more research should be done on those drugs and their use. Cervadil was used to induce my wife, and it was contra-indicated at that time in women with a scarred uterus by “the Physicians Desk Reference”; but that didn’t stop it’s use. This catastrophe didn’t happen in a busy hospital. It happened because the hospital and physicians were not prepared to deal with the profound emergency. I see no benefit to anyone, by lobbying for VBAC’S. Thanks for the reply

To which I replied:

Anthony,

There is about a 0.4% risk of having a uterine rupture with one prior low transverse cesarean in a spontaneous labor (meaning you weren’t induced or given Pitocin or other similar drugs during your labor) (Landon, 2004). One would think that with all the hoopla about uterine rupture, that this rate would be significantly higher than other obstetrical complications.

You might be surprised to learn that uterine rupture occurs at a similar rate to other obstetrical complications such as post partum hemorrhage, cord prolapse or placental abruption! And when we look at infant outcomes, there is about a 6% chance of infant death or oxygen deprivation after an uterine rupture (Landon, 2004) compared to the 12% risk of infant death after a placental abruption (Ananth, 1999).

Yet how many first time moms worry their entire pregnancies about placental abruption? How many considered an elective primary cesarean in an attempt to circumvent abruption? How many were offered, or even strongly pressured, to consider an elective cesarean by their friends, family, or OB? How many where made to feel selfish over their desire to plan a vaginal birth in the face of risks such as abruption?

And where are all the lawsuits resulting from the infant deaths as a result of placental abruption? Why aren’t people outraged that all these babies are dying as a result of selfish moms who should have been prudent and had scheduled cesareans to prevent this tragedy? We hold VBAC to such an impossible standard because the tolerance for risk has been reduced to zero.

Moms planning a VBAC are often made to feel that having a repeat cesarean is the most prudent, conservative choice whereas only selfish women who wish to experience vaginal birth plan a VBAC. Only people who do not understand the statistics would make such a bold claim.

The problem is that most people don’t understand the rate of obstetrical complications in a first time mom. Conventional wisdom and rumor does not give your average individual enough information to adequately compare the risks of a primary vaginal birth, repeat vaginal birth, primary cesarean, repeat cesarean, primary VBAC and repeat VBAC.

That is why we have medical studies because even doctors, who themselves attend thousands of births over their career, do not control for variables like researchers do.

Doctors focus on practicing medicine whereas researchers, who are often medical doctors who still see patients, focus on constructing studies, maintaining records, and controlling for variables. All of this enables researchers to accurately detect and measure the incidence of complications and also identify larger patterns.

One thing we have learned from medical studies is that the risk of infant death during a VBAC attempt is “similar to the risk” of infant death during the labor of a first time mom (Smith, 2002). Should all first time moms have cesareans because their labor is just to risky?

Let’s not forget that while a cesarean could prevent a would-be uterine rupture, placental abruption, or cord prolapse, cesareans themselves introduce many serious risks. In the face of immediate death or damage to mom or baby, these risks are absolutely acceptable. However, when we are performing major abdominal surgery on the other 99.6% of women who will not have a uterine rupture, we are subjecting them to an unnecessary level of risk.

There are several complications that occur during a second scheduled cesarean section at a rate similar to or greater than the risk of uterine rupture during a spontaneous trial of labor after cesarean after one prior low transverse cesarean (0.4%) (Landon 2004). These complications include hysterectomy (0.42%), any blood transfusion (1.53%), a blood transfusion of four or more units (0.48%), maternal intensive care unit admission (0.57%), maternal wound infection (0.94%), and endometritis (2.56%) (Silver, 2006). And while Silver (2006) found that the maternal death rate was “only” 0.07% during a second cesarean, this is 3.5 times higher than the rate of maternal death in a trial of labor after cesarean (0.02%) and 1.4 times higher than the risk of infant death or oxygen deprivation (0.05%) (Landon, 2004.) Keep in mind that all the cesareans included in the Silver (2006) study were scheduled. All the complications noted were a direct result of the surgery, not of any other medical complication.

These are important facts for people to know before they make the judgment of which option is more “risky:” VBAC vs. repeat cesarean. It’s not enough to understand the risks of VBAC, one must also understand the risks of cesarean section. Only then can one see that neither are inherently safe or risky. They both offer a different set of risks. You can read more about the specific risks that cesareans pose in the article The risks of cesarean sections.

Cesareans also have major implications for all future pregnancies and delivery options. The risks of complications increase with each cesarean section which make subsequent pregnancies more precarious which increases the likelihood of a bad outcome for mom or baby. According to Silver (2006), a four year study of up to six repeat cesareans in 30,000 women:

Increased risks of placenta accreta, hysterectomy, transfusion of 4 units or more of packed red blood cells, [bladder injury], bowel injury, urethral injury, ileus [absence of muscular contractions of the intestine which normally move the food through the system], ICU admission, and longer operative time were seen with an increasing number of cesarean deliveries…. After the first cesarean, increased risk of placenta previa, need for postoperative (maternal) ventilator support, and more hospital days were seen with increasing number of cesarean deliveries.

Because the risks of cesarean are so great, they conclude their study with the following statement, “Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.”

Additionally, scheduled cesarean section puts anyone else who experiences a medical emergency requiring surgery in danger because those operating rooms become unavailable. I wonder how often women with true obstetrical complications requiring immediate cesareans, such as your wife, or non-obstetrical emergencies such as car accident or gunshot victims, have been unable to receive that urgent, time sensitive care due to otherwise healthy moms and healthy babies undergoing scheduled elective repeat cesareans and tying up the operating rooms? With 92% of women having repeat cesareans (Martin, 2006), I’m sure it’s happened, especially in smaller hospitals, many of which only have one or two operating rooms. These routine repeat cesareans impact everyone and it’s only going to get worse.

According to the CDC (Menacker, 2010), “The number of cesarean births increased by 71% from 1996 (797,119) to 2007 (1,367,049) [and] In 2007, approximately 1.4 million women had a cesarean birth, representing 32% of all births, the highest rate ever recorded in the United States and higher than rates in most other industrialized countries.” The latest data from the CDC shows that 92% of women have a repeat cesarean (Martin, 2009).  So with 1.4 million cesareans annually, we can look forward to approximately 1 million repeat cesareans annually in the future.  With primary cesarean rates growing, our repeat cesarean rate will grow, we will witness more of the complications identified by Silver (2006), including more maternal deaths, and more cases of people who really need emergency surgery dying because operating rooms are filled with otherwise healthy moms and healthy babies undergoing scheduled cesareans.

You said, “It happened because the hospital and physicians were not prepared to deal with the profound emergency.” I would gently suggest that the problem was more with your hospital than VBAC. They induced your wife with a drug that was contraindicated in a trial of labor after cesarean and then were unprepared for an obstetrical emergency. If your wife had a placental abruption or a serious complication from a repeat cesarean, it sounds like they would have been just as unprepared. That is an entirely separate issue than whether VBACs are excessively risky.

Thank you again for your comments and I wish you the best.

Warmly,

Jen

What do you think?
Leave a comment.

What do you think? Leave a comment.

Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

Learn more >

Free Report Reveals...

Parents pregnant after a cesarean face so much misinformation about VBAC. As a result, many who are good VBAC candidates are coerced into repeat cesareans. This free report provides quick clarity on 5 uterine rupture myths so you can tell fact from fiction and avoid the bait & switch.

VBAC Facts does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts and you should consult a qualified health care professional in all matters relating to your health. Created By: Jen Kamel | Copyright 2017 VBAC Facts | Terms of Use | Privacy Policy

 

Coping with miscarriage II

Coping with miscarriage II

Of all the people coming to this site, it is the women who come searching for information on miscarriage and grief that just really break my heart.  There are so many of us, so I wanted to bring attention to what Candice wrote as well as my response.

Candice left this comment:

My husband and I tried to conceive for over two years. We were so excited when we found out on Oct. 21st that I was pregnant. It was amazing how I could have felt so connected so quickly. Obviously, as soon as we found out we told all out family and friends. I began spotting on December 11th and my husband immediately took me to the ER. I knew right away that something was wrong. My husband, trying to convince me and him, continued to comfort me and tell me everything was going to be fine. They did an ultrasound and determined that the baby had stopped growing at 8.5 weeks. At 8.2 weeks, I was told the heartbeat was at 171. It absolutely hurt me more than words can say because it just seemed more real once I knew there was a heartbeat. I couldn’t and still don’t understand why this happened to us. I, like you, still get upset from time to time but try to “cover up” how I really feel for friends and family, even my husband at times. I just feel that he wouldn’t understand and I feel myself trying to pull away from him and I don’t want this to happen. He is my best friend and he has been there for me through everything and I know he wants to be there for me now, I just don’t want him to know how this has truly affected me. We do want to try again but I am so worried that it will happen to us again, that I am beginning to shut down. How do you overcome something like this? My mother-in-law had a miscarriage before she had my husband and she understands but to others it just like “ok, you had a miscarriage, get over it”. I feel so alone even when I am in a crowded room of family members. Thank you for sharing this piece with others. Although, I cried through the entire thing, I really did need to read that. I am very sorry for your loss.

Candice,

Please know that I’m speaking from the heart and from someone who has been there. Don’t turn away from your husband. He is your partner and it is very likely that he is hurting to. My husband deeply mourned our miscarriage. Men mourn differently than women. Please do not let this divide you. Comfort each other. If he was hurting as deeply as you are, wouldn’t you want him to tell you? Be honest with him about your feelings and fears.

Please be patient with yourself. It has hardly been a month from when you miscarried to when you left this comment. It could take several months for you to get to a place where you can think of it and not cry. And that is ok and completely normal.

Do you have any close friends who you can share this time with? If not, family or even a message board might help you feel less alone during this time. I think if you start to share just a bit amongst friends, you would be surprised how many women have experienced miscarriage. I know, a lot of people don’t understand why it’s “such a big deal.” But, honestly, I didn’t either before I experienced it. I could think about how much it could hurt, but I never knew what it felt like in my heart. Since they haven’t been there, they don’t understand.

When you get pregnant again, you might not feel that excited. You might feel a mixture of subdued happiness and fear. I know I tried to maintain some emotional distance, as much as possible, for the first three months. It is horribly scary to think that it could happen again. There are women all around us who have experienced multiple miscarriages and are still living life through their pain. I would look at women shopping at the store, walking down the street and think that some of those women had to experience miscarriage and that we all shared this pain. It gave me some peace.

This might seem out of left field, but have you looked into a local Holistic Moms or ICAN chapter? I’m certain that you would find others who have not only experienced miscarriage, but could provide you with loads of compassion.

I’m sending you a huge hug Candice. Please go to your husband, hug him, and let him comfort you. This is what we committed to when we married – for better or for worse. This is a hard time. You will survive it. I know it doesn’t feel that way now. You might feel like you will never be happy again. The only thing that will make this better is time. Please stay in touch and let me know how you are doing. I’m wishing you peace.

Warmly,

Jen

What do you think?
Leave a comment.

What do you think? Leave a comment.

Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

Learn more >

Free Report Reveals...

Parents pregnant after a cesarean face so much misinformation about VBAC. As a result, many who are good VBAC candidates are coerced into repeat cesareans. This free report provides quick clarity on 5 uterine rupture myths so you can tell fact from fiction and avoid the bait & switch.

VBAC Facts does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts and you should consult a qualified health care professional in all matters relating to your health. Created By: Jen Kamel | Copyright 2017 VBAC Facts | Terms of Use | Privacy Policy

 

When I Had My Miscarriage

When I Had My Miscarriage

I had completely forgotten that I wrote this piece until a month ago.

I was with a dear friend who is getting married and we were visiting with her mom.  We were talking about birth and her mom asked me, “You had a miscarriage, didn’t you?”

The question kind of caught me off guard.  Funny how even though it had been 18 months, the pain was still faintly there.  During that time, I had my sweet VBAC baby, but when I think of that miscarriage… it still makes me sad.

My friend’s mom, a psychologist, knowing that I have this blog, encouraged me so share something I wrote after the miscarriage and a recent post on the ICAN email list reminded me again tonight.  My friend’s mom said, correctly, that people don’t talk about miscarriage much and that many women, in trying to find a way to cope, are left feeling alone.

I shared with her how months after my miscarriage, I was out with my in-laws and just broke down crying in the middle of lunch.  It’s hard because unless someone has experienced a miscarriage, they just don’t understand.  And this makes perfect sense.  While you may look ‘normal’ and ‘all better’ from the outside, you’re not.  Grief takes a long time to work through you.  It’s weird how this little bundle of cells, this little baby in the making, who I just became aware of two weeks prior, become so utterly important to me so quickly.

Other people want you to move on because they care about you and, I’m sure partly, because they don’t know how to make you feel better, or feel awkward in the presence of your grief.  So not only are you dealing with your extreme sadness, but you are uniquely aware of how uncomfortable other people are with your miscarriage, so you are simultaneously downplaying your feelings and/or trying helping them cope so they will feel comfortable around you.

My miscarriage was on September 13, 2006.  I will always remember that date because of 9/11 then my husband’s birthday is 9/12.  This is bittersweet.

I wrote this on December 20, 2006 while working on our annual Christmas letter.  After I was done, and looked at my pain as it spilled out all over the page, I thought it probably wouldn’t make for good Christmas letter material.  On one hand, I wanted to be ‘real’ rather than the ‘Our life is just great here are the hundred reasons why’ material that usually makes up Christmas letters, but I didn’t know how to temper my pain.  Just saying, ‘I had a miscarriage’ seemed to short, to fleeting, but at the same time… I wasn’t ready to deal with everyone’s’ response.  My friends and a few family members knew, but most people didn’t.  Frankly I feel really uncomfortable when people feel sorry for me.  I want to say, “It’s ok,” but it’s not… where do you go from there?  Obviously, I didn’t include my ‘manifesto of pain’ in our Christmas letter.  I included the typical happy stuff and left it at that.

**********************************************

In September 2006, after many months of hoping, I was pregnant.  And for two weeks, I smiled with each wave of nausea and dreamed of my daughter being a sister and eagerly awaited May 3, 2007 when our next baby would be born.  But it was not to be.  On the second day of our big Washington trip, my miscarriage began.

I never really understood how painful an early miscarriage could be.  I only knew for two weeks that I was pregnant.  How attached could I be?  It was amazing how painful this experience has been.  I sit here three months later, and I still cry.  I don’t cry everyday.  I try not to cry in front of my daughter.  It is because of her that I have been able to go on without completely breaking down.  Her presence requires me to move forward with each popsicle on a towel in the living room and each pair of pee soaked Tinkerbell underwear.

When I was pregnant with my daughter, I had no idea what I was in for.  I was working – conflicted on whether I would/should/could quit once she was born.  I was selfish.  I really thought I lived a busy life.  I really thought I had a full schedule.  I thought I understood stress, exhaustion, and hard work.  I was all the things people are before they become parents.  And while I was excited to have a baby, I could not possibly comprehend how she would impact my life and how much I would love her – desperately, deeply, completely.  How I would do anything for this little girl.

So when I was pregnant this time, I knew all this.  I knew how much work it would be, how hard it would be, and how much I would love this child.  And I was so excited for my daughter to have a sibling.  I’m also more settled in my life now than I was when I was pregnant the first time.   We were so excited about this baby.  (My daughter has told us that she wants a baby brother.  It now breaks my heart to hear this request.)

So when I started spotting five days before that day in Seattle, I was at my parents’ house.  After several years of charting my cycle (daily cervical fluid, cervical position, and when I’m really motivated, waking temperature), I learned how my cervix feels before I start my period… and that is how it felt that day.  Even my lay knowledge told me that something was wrong.  My uterus preparing to empty doesn’t seem compatible with a pregnancy.

I went to urgent care and the MD there told me everything was fine.  He told me to stop feeling my cervix, that I would get an infection.  He sent me home with a condescending pat on the back, completely dismissing what I was saying about the state of my cervix.

I continued with our plans for that day – meeting friends at Disneyland – but did so with a heavy heart.  I certainly hoped that the MD was right, but my instinct told me differently.  And for the next five days, I tried to curb my enthusiasm, which was hard.  We went out to dinner that weekend, as planned, with my in-laws and told them that we were pregnant.  I really tried to tell myself that the doctor was the expert, not me.  I should listen to the experts.  Everything will be fine.

So when I woke up that morning in Seattle, a thousand miles from home, and saw bright red blood, I tried to justify it every way I could.  “I spotted last time and everything was fine.”  “It’s not that much blood.”  But this was more than just spotting.  Even though I had to put on a maxi-pad to cope with the bleeding, I was still trying to justify and deny what was happening.  My husband and I were at breakfast, a couple hours or so after we woke up, and the bleeding was intensifying, not decreasing.  It was surreal.  We decided to go to the emergency room.  I got up from our table and walked into the lobby.  I asked the front desk clerk where the closest hospital was and requested that she call a taxi.  I asked if the hospital was a good one.  I really thought, “I’m going to feel so dumb when we get there and they tell us that it’s fine.”  When the cab driver asked if I was ok, I meekly said, “I think I’m having a miscarriage.”

The people working that day at Virginia Mason ER were amazing.  I was wondering how we would be received based on my experience just a few days before.  They saw us almost immediately.  The nurses were so nice, gentle, respectful and the MD was very candid when he told us that he and his wife had experienced this as well.

No medical speak.  Just three human beings connected through pain.

I thought I saw a heartbeat on the ultrasound monitor and for 30 minutes I really had hope.  Long story short – there was no baby.  I will never forget my husband’s face.  The doctor came in the room to tell me and my husband was just outside the door watching our daughter as she ran around in the hall.  The doctor said development had stopped “some time ago.”  My husband heard what the doctor said and we made eye contact.  Thankfully, I didn’t need a D&C as my uterus was already almost completely empty.

We left the hospital a few hours later and I will never forget how physically weak I felt.  How emotionally numb I was.  I sensed the profound sadness deep inside my heart, but it felt far away.  It was as if I looked through frosted glass and could see my fuzzy, deformed, vaguely familiar pain. That was the part of me that didn’t want to deal with it.  I didn’t want to deal with what this all meant and ruining our much anticipated family vacation where we would attend a family wedding that weekend.  (Thankfully no one but my parents knew I was pregnant.  I don’t think I could have gone if I was receiving continual condolences and sad sideways glances.)

We walked down the beautiful hill towards our hotel and contemplated, “What next?”  I certainly didn’t want to go back to the hotel.  And do what?  Cry?  Lay in bed and look at the ceiling as our 2 1/2 year old lost her mind trapped in a hotel room?  Wow, sounds like a great time.  No, I didn’t want to do that.  I wanted to walk.  So, we did.

Slowly, gently planting one foot firmly before picking up the other, holding my husband’s hand as he pushed our sweet girl all bundled up in her stroller.  We walked by beautiful window displays.  We walked to Pike’s Place.  We spent several hours there.  Slowly walking.  It was a crisp day.  It was nice to wear a jacket.

After we got back to the hotel, my husband took our daughter to the pool at the hotel.  I laid in bed and looked at the ceiling.  Looked out the window.  Looked at the TV.  And I cried.  I cried loudly.  It was the first time I could really let loose and let it out.  I didn’t want to upset our daughter, so I had tried to keep everything ‘under control.’

So with each wail, I tried to push the pain out up and out of my mouth.  Hoping that if I just got all the pain out, I could feel better.  I wasn’t going to let this ruin our vacation.  We had plans to go to the zoo, the Children’s Museum, the Space Needle… and damn it, I was going to have a good time.  And I would smile.  Even though my sadness, I would enjoy my family.  So after that cry, I put it in the back of my mind – to deal with later.  Later, after I stopped thinking I’d get pregnant again as soon as possible, after we got home and I saw my friends with their sad faces.  Later when I could face my pain.  And, when we got back, I did cry a lot.

Even now, there are times that I cry.  It’s hard how the pain doesn’t miraculously disappear.  It just goes beneath the surface.  I hate the phrase, ‘Move on.’  Only people who have never experienced a great loss would have such a cavalier attitude towards grief.  As if once all your pain goes away, once you ‘move on,’ then you are ‘all better.’  What does that mean?

You don’t think about it?  You don’t cry?  You are never sad again?  Please.  The pain never goes away – it just isn’t so raw anymore.  The jagged edges of my pain are worn away and I don’t think about it all the time.  But just because I’m still sad sometimes, doesn’t mean I’m not still doing laundry, potty-training, and enjoying my life.  It just means I’m still sad.  It means I wish I was writing you 5-months pregnant, but I’m not.  And that sucks.  And it’s quite all right, thank you very much, if I’m ‘still’ sad about it.

A friend of mine who has experienced miscarriage twice told me that it was totally weird – no one will mention it to you.  People will act like it never happened.  And being on the other side of it, I know what it feels like to not want to upset someone.  To not know how to bring it up or what to say.  To simply be uncomfortable in the presence of someone else’s massive loss.  But now being the one ‘it’ happened to – it’s weird.  I’d talk about it if someone asked me.  But no one does.

I share this personal pain because I hope that someone else will find comfort, knowledge or understanding.  I don’t pretend to presume that I could have this power.  I just know how much strength I have gained from my brave friends who have shared their pain with me.  If it wasn’t for these friends, this could have been a very lonely, isolating event but instead I learned to share a quiet, communal understanding with women who have walked this painful well-worn road before me.

Jen

What do you think?
Leave a comment.

What do you think? Leave a comment.

Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

Learn more >

Free Report Reveals...

Parents pregnant after a cesarean face so much misinformation about VBAC. As a result, many who are good VBAC candidates are coerced into repeat cesareans. This free report provides quick clarity on 5 uterine rupture myths so you can tell fact from fiction and avoid the bait & switch.

VBAC Facts does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts and you should consult a qualified health care professional in all matters relating to your health. Created By: Jen Kamel | Copyright 2017 VBAC Facts | Terms of Use | Privacy Policy