VBAC Success for Joy Szabo

I posted a few months ago about Joy Szabo's story. She was the woman from Page who was planning a VBAC with her third child, and then found out that she would be forced to have a repeat c-section due to the new guidelines of her hospital. After relocating to Phoenix and finding a supportive health care provider, hospital and doula, she was able to have her VBAC.

You can read the CNN article about her VBAC experience here.

You can also read an ICAN article where they interviewed Joy here.

I think that Joy is an amazing example to other moms out there who would like their bodies and birth choices respected. She didn't give up, even when it meant moving hours away from her home and family, and accruing expenses she had not planned for. Joy had to sacrifice a lot, but she did it anyway, because she felt it was the right thing for her and her family.

I feel that it's unfortunate that she had to sacrifice so much just to have the natural birth that she should have been able to have in Page. Hopefully all the attention and media that has surrounded her story will help others to realize that there are a lot of changes that need to be made when it comes to hospital guidelines.

In my opinion, no woman should be denied the choice to birth the way she feels is best for her and her child. Mothers need options and support based on evidence based medicine, not bans and restrictions that are largely influenced by insurance policies and finances.

13 VBACs and Counting

I'm not sure how many people are fans of the TLC show 18 kids and Counting, but I LOVE it. I enjoy watching the Duggar family, and I think very highly of them. On the episode last night, Michelle and Jim Bob were celebrating their 25th wedding anniversary. They have been married for 25 years and have had 18 children in the process. The producers gave Michelle (the mom) the challenge of sharing about each of her children. They asked her to tell about each of their births as well as their personalities.

This is what I got from watching. I can't say that I'm 100% correct but it was my interpretation of what she shared.

Josh- Hospital birth with epidural

John David & Jana (twins)- C/S for pre-eclampsia

Jill- Natural VBAC

Jessa-Natural VBAC

Jinger- Home VBAC

Joseph- Home VBAC

Josiah- Natural VBAC

Joyanna- Natural VBAC

Jedidiah & Jeremiah (twins)-Natural VBAC

Jason- Natural VBAC
James-Natural VBAC

Justin- Natural VBAC

Jackson- C/S for breech presentation

Johannah- Natural VBA2C

Jennifer- Natural VBA2C

Jordan- C/S for transverse presentation

Michelle is a big supporter of VBAC and home birth, choosing to have cesarean sections only when it is medically necessary. I think she is a great example. It is amazing to see how many VBACs she has had even though some of Arkansas hospitals have VBAC bans.

Here is an excerpt from the Duggar family website where she discusses her decisions surrounding her births.

"As with any first time birth experience you might have fear of the unknown. As we approach each birth there are still the concerns of the unknowns such as the labor and delivery, each one has been different but having had the experience over and over does help some. Each time we have prayed for the health of mom and baby, and asked for a healthy, easy delivery.(As much as possible when were talking about labor!)

I’ve had three C-sections, one with our second birth, twins, Jana and John-David, with our 15th, Jackson and with Jordyn-Grace. All the rest have been vaginal births, 13 of which have been VBAC’s. (Vaginal Birth After Cesarean) We were hoping to have another VBAC with this last delivery.

I would say the greatest change that I have seen in the field of obstetrics, and I might add that it is very troubling to me, is the idea that once you’ve had a C-section you must have a C-section for any other pregnancy. It is much healthier for mom and baby to avoid major surgery and all the complications that go along with a C-section if possible. Granted, there are health situations that would warrant such, but for years obstetrics encouraged TOL (Trial Of Labor after previous C-section) with many successful healthy vaginal births. It was quite alarming to be told that I could no longer have a vaginal birth due to hospital or insurance companies regulations. It appears that what is best for the patient is not the priority with this decision.

I feel our health care is being jeopardized by this unhealthy approach. Doctors are having to tell their patients that they no longer offer VBAC assistance due to hospital regulations and some might even state to the patient that they are not safe so as to avoid confrontation. Statistics prove much differently.

For the many women that find themselves in this situation, ICAN is an organization that is very helpful in gaining more information on this topic. One of which I believe will be reversed in the near future as more women make a clear statement to health care providers and insurance companies as to how they would prefer to deliver there babies in a safer, healthier manner. (Now I will step off my soapbox!)
We are thankful our hospital allows trying a VBAC as long as they have an anesthesiologist on hand in case there is an emergency."

Michelle is expecting again, and I am curious as to whether or not she will have the support of her provider to attempt another VBAC after 3 c-sections.

It seems that for the most part, the option of having an elective repeat c-section is presented as if it holds no risk to the baby. Some women choose to forgo even attempting a VBAC, in order to protect their baby from any potential harm. We hear so much about the danger of VBAC and uterine rupture, to the point of where hospitals and doctors are refusing to offer it as an option. Yet, we hardly ever hear anything bad about choosing a c-section instead.

The truth is that they BOTH have risks. With both options there are no 100% guarantee of a healthy mom and baby. Because of this, mothers need to be well informed with what those risks are before they make their decision, and ultimately decide which risks she is ready to take. I have talked with women who have been scared by their doctors when it comes to trying for a vbac. They start to base their opinion of vbac on their doctor's fear instead on what is fact, or what they truly feel best about. My own OB/GYN informed me that "VBACs are way too risky," and yet didn't say anything about the risks involved with having another c-section.

It is very one-sided unfortunately, but the information is out there for those who care to have it. This is not to say that a mother would be wrong for choosing a ERC instead of a VBAC. I just think that women need to be completely informed about each option before they decide.

I personally, didn't know about the risks to my girls before I had my c-section. I know I signed a c-section consent form right before they wheeled me into the OR, but I can't recall what was on it. One of my daughters did end up in the NICU, which wasn't what we were anticipating. After learning more, I am not surprised that it did happen as babies are TWICE as likely to end up in the NICU following a cesarean section then after a vaginal birth. It's just one of the risks every mom should know about.

Repeat Cesareans may put babies at risk

This article can be found here.

AURORA, Colo. (May 22, 2009) – The babies of women who have an elective repeat Cesarean delivery are twice as likely to be admitted to the neonatal intensive care unit than babies of women who have a vaginal birth after Cesarean (VBAC). That’s according to a new study from the University of Colorado Denver School of Medicine.

The study shows babies born to women who have elective repeat Cesarean deliveries also continue to need oxygen in the neonatal intensive care unit.

“The costs of the birth for the mother and the infant are greater in the Cesarean section group,” according to the lead author of the study, Beena Kamath, MD, MPH, an associate professor of pediatrics at the University of Colorado Denver School of Medicine.

Kamath and researchers from UC Denver, Colorado School of Public Health and The Children’s Hospital looked at the records of 672 women who gave birth at University of Colorado Hospital. Each of the women had one prior Cesarean delivery. Three-hundred-forty- three decided to have another Cesarean while 329 planned a vaginal birth.

“Controversy exists on the recommended mode of delivery in women who have had one prior Cesarean section,” Kamath said, “It is important for women to discuss the risks and benefits of their delivery options with their doctor, and also to realize that the decision to have their first Cesarean section may affect the way they deliver if they have more children.”

The study appears in the June issue of Obstetrics & Gynecology.

AZ Woman Threatened With A Court Ordered Cesarean

This morning I saw this article on Facebook that was posted by Jill at the Unecessarean. It is originally from the Lake Powell Chronicle and it caught my eye, as I was born in Page at this same hospital. It is the ONLY hospital within 120 mile radius.

*I highlighted a few parts.

Hospital policy pains expectant mom

Posted: Wednesday, Sep 30th, 2009BY: Mary Forney — Lake Powell Chronicle

PAGE – A pregnant woman’s pleas not to have an unnecessary caesarean are being ignored by Page Hospital administrators.

Joy Szabo, 32, said she is upset with Page Hospital’s general ruling in June prohibiting vaginal births after cesareans (VBAC). The mother of three children, she has given birth to all of her children at Page Hospital, the only hospital in the immediate area. A placenta eruption caused her to have an emergency cesarean delivering her second child, but the hospital allowed her third child to be delivered naturally two years ago.Now pregnant with her fourth child, she is being forced to have a caesarean due to lack of hospital staffing.

“Page Hospital is, as many small communities are, challenged with resources,” said Chief Executive Officer Sandy Haryasz. “Page simply does not have the physician resources to respond to an emergency. Currently, we have two physicians who are delivering babies and a third physician will be joining us next week.

“Three physicians cannot provide the coverage recommended by ACOG (American College of Obstetrics and Gynecology). The physicians must be immediately available because of the risks of a VBAC and we cannot provide that in Page. In addition, we cannot provide an anesthesiologist to be readily available because we only have one anesthesiologist.”

Joy thinks it is against her legal rights to force her to have unnecessary surgery that might place her and her baby at greater risk of harm than delivering naturally. Her only option to having natural birth is to travel to a women’s care clinic in Phoenix or have unassisted home delivery.

While the hospital’s new policy not to do VBACs is unwritten, Haryasz said the decision is not based on money, but on there not being enough “volume” to warrant hiring another physician or emergency anesthesiologist.

“This is about providing quality safe care to all our patients,” Haryasz said. “The hospital would have to cancel surgeries or any other procedure because that doctor or anesthesiologist would have to be available to her while she’s in labor, which could take hours or days.”

Joy’s husband, Jeff, 44, is supporting what he thinks is his wife’s right to choose.

“I have talked with Banner Health officials who have said it’s just their policy,” Jeff said. “It’s a legal decision – not a medical decision. My wife’s plight is indicative of the health-care system in the U.S. They make money off of people’s suffering.

“Consequently, medical care is dictated by cost and insurance companies and not by what’s best for the patient.”Joy said she voiced her concerns at a board of directors meeting and has met twice with Haryasz.“I asked Sandy what would happen if I just showed up refusing a c-section and she said they would obtain a court order,” Joy said.

“They don’t want to allow VBACs because she said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency.“I wish her luck explaining to a judge that she is insisting I have a medically unnecessary surgery.”

ACOG currently supports VBAC deliveries, citing on their Web site at www.acog.org, that the benefits include the avoidance of abdominal surgery, shorter hospital stay, lower risk of infection, less blood loss, and less need for blood transfusions.The risks include a rupture of the previous cesarean scar during delivery, or in rare circumstances, rupture of the uterus.

Haryasz said that despite ACOG’s recommendations and the favorability of success with VBACs, Page Hospital is sticking by its decision to no longer perform natural deliveries after cesareans.“We respect our patient’s wishes should they choose VBAC, however the medical staff and administration have determined that deviating from national standards and performing this procedure here is a risk that is unwarranted and too great for our mothers and babies,” Haryasz said.The Szabos think that lack of staffing is not sufficient cause for Joy to be forced to undergo unwanted, unnecessary surgery.

“My doctor doesn’t have a problem with me having natural delivery, but said that the hospital does,” Joy said. “The fact that I successfully had a VBAC two years ago lowers my risk for rupture, but that doesn’t matter since the hospital has decided that all VBACs have to have an ‘elective c-section.’ I think my definition of ‘elective’ differs from theirs because I don’t want this.”

2 Years Later

It's been just over two years since my girls were born via c-section and I suddenly became a mother.

The night before their birthday I was busy decorating their cupcakes. As I glanced at the clock, I couldn't help but revisit what exactly was going on at that time two years ago. Although a lot of the events surrounding their birth aren't positive to look back on, I am so grateful for my girls and the wonderful blessing they are in my life. I am also grateful for all that I have learned from their birth and am still learning. I know that we are given challenges in life so that we can learn and grow, and I feel like I have been given the opportunity to do just that.

Why Your Due Date Isn't When You Think

Here's a great article I read recently about why most estimated due dates aren't accurate.

I highlighted some of the information that stuck out to me.

The Lie of the EDD: Why Your Due Date Isn't when You Think

This article can be found here.

We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call
ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done".

The folly of Naegele's Rule

The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.

The inaccuracy of ultrasound

First trimester: 7 days

14 - 20 weeks: 10 days

21 - 30 weeks: 14 days

31 - 42 weeks: 21 days

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League.

ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery.

Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.

The Shape of a Mother

{this picture is from The Shape of a Mother website}

I got my first stretch mark when I was around 30 weeks. I had been so proud of myself {up until that point} for maintaining a tight streak-free stomach, even though I was measuring around 40 weeks. My doctor even marveled at how nice it looked. Of course, it was only a few days later when I noticed a tiny silver firework that had secretly exploded above my protruding belly button. After that, it was all downhill {Palmer's butter promise my butt!} as my stomach turned into what I referred to as the "battle zone". I still loved being pregnant, but as my belly continued to grow and grow, my 22 year old mind worried itself as to how this skin would look after the fact.

I'd seen the moms that had their babies and were suddenly back into their jeans again, just like magic. But they all had one baby, not two, so I came to terms with the fact that my stomach would never look like theirs, and it would probably be a while before I got back into my jeans. In the OR during my c/s, I even told my OB to take off as much excess skin as he wanted before he stitched me back up. He laughed and replied, "What excess skin?". I might have been doped up on drugs but I wasn't stupid. I went home looking like I was 6 months pregnant, and I cried when I saw my stomach in the mirror weeks later.

It's been almost two years, and I'd like to say that I've regained most of my body, or at least as much as I could. I still have stretch marks and extra skin that I would love to donate to anyone who needs it {let me know}, and my belly button still refuses to smile. After nursing twins for 10 months, well let's just say that my ladies found retirement in Smallville. The truth is I don't regret any of it. It's only a testament to me of how strong and amazing my body is and how grateful I should be to God for blessing me with it. My body can grow and feed two babies, TWO BABIES! It can stretch and mold and could fulfill every task it was given even when it was twice the work. It took me a while to feel this way, but I'm glad that I do.

After reading a few posts on the Unecessarean, I noticed a link for "The Shape of A Mother."It is a compilation of mothers from different backgrounds and births sharing how their bodies have changed after pregnancy and birth. I like it because it's real, and there aren't any airbrushed pictures on this one. You won't see any Angelinas post-tummy tuck, or JLOs in their itty-bitty bikinis. Just real women with real bodies, that are striving to embrace the changes their bodies made to bring life into the world.