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Vaginal Birth After Cesarean (VBAC)

Vaginal Birth After Cesarean (VBAC)

Many people view the act of giving birth as being just about the baby. But it is not! Childbirth is as much about the new life as it is about you, the mother. Your desires and your wishes do matter. So, if you want to give birth naturally though your previous was a cesarean birth, you have the right to plan and hope for a VBAC.

A c-section can be a lifesaver, but for some people, it can also leave that personal touch out of childbirth. There are many reasons women need surgery to give birth, and none of them are trivial.

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If you had a cesarean but now want to opt for a VBAC, your work is cut out for you! Let us give you all the scoop on VBAC.

Why should you even try for a VBAC?

You had a Cesarean last time, and your baby came out healthy and happy. So, why rock the boat this time around? There are many reasons you and so many other women worldwide contemplate a VBAC. Here are some of the major reasons:

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  • Faster recovery is one of the biggest reasons women opt for VBAC. With a little one at home already and another one about to make their entry into the world, the last thing you need is to hobble around in pain.
  • For many women, a cesarean birth feels impersonal and takes away some of the early chances for bonding with their newborn. If that is how you felt about your previous delivery, VBAC may be right up your alley.
  • Breastfeeding is one of the most beautiful aspects of giving birth. But a c-section can make breastfeeding difficult. A VBAC can help you establish an early breastfeeding bond with your newborn.
  • Once a c-section, always a c-section! For a long time now, a cesarean birth marked the end of any possibility of a natural delivery in the future. If you are planning to have more than two kids, remember that each c-section makes the chance of a VBAC dimmer.
  • It may feel irrational to others, but how you want to give birth is entirely your choice. So, a VBAC is a good idea just because you want to experience a natural birth!

What are the risks associated with VBAC that you should know about?

A natural birth may be your dream, but the ultimate aim of childbirth remains a healthy baby and a healthy mother! That is why it is important that you know about all the risks associated with VBAC before you jump on the bandwagon.

  • The biggest reason doctors are wary of encouraging a VBAC is a uterine rupture. If you had a uterine rupture during your previous delivery, you should not even attempt a VBAC this time around – yes, it is that risky. But if you had a relatively healthy, low transverse (bikini) cut cesarean, your chance of getting a uterine rupture is as low as 0.5% to 1% (depending on other health issues).
  • A uterine rupture can cause infection and brain damage to the baby.
  • In some extreme cases, a uterine rupture can also necessitate a hysterectomy (removal of the uterus). Remember that a partial hysterectomy does not cause immediate menopause but will leave you infertile.
  • In most cases, the worst that can happen during a VBAC is a failed labor process and an emergency c-section.

What different factors determine the success rate of a VBAC?

You’ve seriously considered the risk factors as they relate to your specific circumstances and still want to opt for VBAC? Good for you! In fact, studies show that a good percentage of women (60% to 80%) go on to have a successful vaginal delivery via VBAC. Some of the factors that determine the success rate of a VBAC attempt include:

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  • Check your previous c-section scar. If you had a low transverse uterine incision last time, you have a good chance of having a successful VBAC. But if you have had more than one c-section, your chances will go down.
  • If your pregnancy is progressing smoothly and none of the factors that led to a cesarean last time exist during your current pregnancy, a vaginal birth is no longer a dream for you.
  • If you go into labor without assistance before or on your due date, you are on track for a VBAC. But if you are already past your due date, the chance of a natural delivery will dip.
  • Another factor that can make VBAC difficult is macrosomia; that is, if your child is larger than usual.
  • According to studies, your age too can play a significant role in VBAC. Younger mothers are more likely to come out of a VBAC successful and without complications. But if you are 35 or above, you are 39% more likely to experience complications and a failed labor trial during VBAC.
  • Your race is also a factor that determines the success rate of a VBAC. White women are more likely to have successful VBACs than women of other races. But the good news is that non-white women are 40% less likely to experience uterine rupture during a VBAC.
  • Obese women are 50% more likely to have a failed VBAC when compared to underweight women.

How can you prepare for a successful VBAC?

If your heart is set for a VBAC, start planning for it. There are things you can do to increase your odds of a successful VBAC.

  • Research, research, and research some more! If you are going for a VBAC, make sure you know the ins and outs of it. You can even take VBAC childbirth classes along with your partner.
  • Talk to your doctor about your wish for a vaginal delivery and discuss your complete medical history with him. Many doctors try to talk women out of a VBAC. But unless there is a good reason, hold your ground. If your health care provider is not supportive of a VBAC, look for someone who is!
  • Look for a hospital that is not just supportive of a VBAC but also has a high success rate in it. The hospital should also be well-equipped to handle any emergency situation.
  • Despite popular belief, your doctor can induce labor during a VBAC. But it will be best if things kick-start naturally. So, allow your body to go into labor naturally.
  • If you are obese, talk to your doctor about the risks while opting for a VBAC. In fact, it will be a great idea to lose some weight before you become pregnant!
  • Eat well and exercise regularly. A healthy pregnancy is surely a plus if you are trying for a VBAC.
  • Most importantly, be ready for a c-section! No matter how perfect everything is moving, the slightest of problems may warrant an emergency cesarean.

“Birth is not only about making a baby. Birth is also about making mothers – strong, capable, competent mothers who trust themselves and know their inner strength”. Barbara Katz Rothman

Remember this beautiful quote whenever you find yourself doubting your body. Trust your body and your doctor.

A VBAC can make you feel powerful and strong, reaffirming your inner warrior! But even if you do end up with another cesarean, remember, being a mother itself is a victory. Giving birth is only the first step, you have a whole battle lined up. So, plan a VBAC if it’s right for you but don’t let it take over your life.

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Featured photo credit: VBAC via flickr.com

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Last Updated on January 12, 2021

Signs of Depression in Children (And How to Help Them to Overcome It)

Signs of Depression in Children (And How to Help Them to Overcome It)

Children, just like adults, can be depressed. Sometimes seemingly normal children with no major life issues can become depressed. It is the result of a chemical imbalance in the brain that causes clinical depression to occur. There are specific signs that you should recognize in your child if they are depressed. Getting them help and treatment is crucial to their mental wellness.

In this article, we will look into the signs of depression in children and how parents can help them to overcome it.

Signs of depression in children

The DSM (Diagnostic and Statistical Manual of Mental Disorder) is the widely accepted instruction guide that professionals utilize for diagnosing mental disorders. The DSM characterizes a Major Depressive Episode as depressed behaviors that consistently last for two weeks or longer. Therefore, if your child has been “down in the dumps”, feeling hopeless or having sadness for more than two weeks, it should be cause for concern and investigated.

Below are signs of depression according to the DSM manual. The individual must have at least five of these behaviors present for a period of two weeks or longer to be officially diagnosed as having MDD (Major Depressive Disorder). Below is a summary/generalization from the DSM manual:

  • Feelings of deep sadness or depressed mood that last most of the day (for two weeks or more). For children they can present as irritable rather than sad.
  • Diminished interest in activities (again majority of the day or all the time).
  • Significant weight loss (not through dieting), or a decrease in appetite. In children, they fail to make expected weight gains while growing.
  • Difficulty sleeping (insomnia).
  • Either a slowing of psychomotor abilities/actions or an apparent agitation of these psychomotor abilities. This means that they either have moments that lack purpose and seem to be done because of agitation and tension or there is a significant slowness/retardation of their speech and physical actions.
  • Fatigue and loss of energy.
  • Feelings of worthlessness or excessive guilt every day.
  • Difficulty thinking, making decisions, or concentrating every day. This may be reflected in their grades.
  • Preoccupation with death and dying or suicidal thoughts.

Please note that if your child is suffering from the loss of a loved one and is processing through the stages of grief, it is normal to have these signs of depression. If they seem to be stuck in the depression stage, then it is time to pursue grief counseling to help them along in the grieving process.

However, if they are not suffering from a bereavement or a medical condition that would cause the above symptoms, then they should be taken to a professional for possible diagnosis and treatment of MDD (Major Depressive Disorder).

How to help your child with depression

Depression is not to be taken lightly. Especially if suicidal thoughts are present. The child’s feelings and emotions are real and must be taken seriously. According to the National Institute of Mental Health (NIMH), suicide is the number two cause of death for individuals between the ages of 10 and 34.[1]

Professional help is recommended if you believe your child fits the criterion for MDD (Major Depressive Disorder). You can take your child to their paediatrician for an evaluation and referral. Depending on the severity of the symptoms, they may benefit from medication such as anti-depressants.

Most professionals do not dispense medication as the first remedy for depression. Instead therapy is the first line of defense against depression, with medication being paired with therapy if the therapy is not enough or the symptoms are severe enough.

Testing

There are assessment tools that professionals can utilize to help in properly determining whether your child is depressed. The three tools used in assessing depression in children are:

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  • The Children’s Depression Rating Scale (CDRS)
  • Children’s Depression Inventory (CDI)
  • Clinical Global Impression (CGI)

Taking your child to a professional mental health counselor, psychologist or psychiatrist can help ensure proper testing and assessment occurs.

Therapy

There are many types of therapy available today. It is important to find a professional that specializes in childhood depression and the treatment of such.

Cognitive behavioral therapy is one of the leading therapy methods in treating childhood depression. For younger children, play therapy is useful in treating childhood depression as children are often able to better communicate through play than conversation alone.

What parents can do at home to help their depressed child

Besides seeking for professional help, there are a couple of things that parents can do at home to help their depressed child:

1. Talk with your child about their feelings in a compassionate and empathetic manner.

It can feel high pressure to sit face to face and ask your child about their feelings. However, going on a walk, playing a board game or playing alongside your child (chose whichever is age appropriate for your child) can allow them to relax and open up about their feelings.

Ask your child open ended questions that require more than a simple yes or no to engage in more meaningful conversations. Never judge while they are being open and honest with you because it will inevitably cause them to shut down and move away from being open with you.

It is okay to allow for periods of silence during the conversations because sometimes the child is processing their thoughts and emotions during your time together. You don’t have to fill the space and entire time with talking as silence at times is helpful.

2. Provide activities that help them relax and de-stress.

For smaller children, there are simple ways to help them relax.

Provide play opportunities that they find relaxing such as coloring, painting, working with Play-do or clay, or playing with sand and sand toys. Again, find activities that interest your child and are age appropriate are helpful in making them relaxed.

3. Limit screen time.

Technology is not helpful in making your child less depressed. It can often be an escape that keeps them from further opening up about their feelings and emotions.

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Limit time in front of the TV, laptop, smart phone, video games and tablets, etc. Any electronics that seem to prevent your child from face to face interactions should be limited. Ask Dr. Sears cites that researchers have found kids who have higher levels of screen time are at greater risk for anxiety and depression.[2]

Provide alternate activities to replace the screen time such as hiking, crafting, drawing, constructing, biking and playing outside, etc. Some children may be so dependent on their screen time as their source for entertainment that they may need you to participate in alternate activities alongside them in order to get engaged in the activities.

You can’t simply tell your child to go outside to play if they are suffering from depression, lack friends and are used to sitting down and playing video games each day after school. Go outside with your child and do a nature hike or take your child to a playground and have fun together to get them engaged in these alternate activities.

4. Promote outdoor time and physical activities.

Encourage your children to take part in activities that especially involve nature such as nature hikes. Do these activities with them to help them engage in the activities. Again this is an opportunity for open conversations to occur and quality time to take place.

5. Help your child when problems and difficult tasks arise.

Assist them by helping them break down the task into smaller and more manageable parts. Children with depression often have difficulty taking on large problems and tasks and find them overwhelming. Helping them by breaking down the task into smaller and more manageable tasks will assist in helping raise their confidence when the small tasks are mastered.

Small tasks mastered lead to bigger tasks being mastered over time. It is a process over time, patience and a willingness to work alongside your child. This does not mean doing the task or taking on the problem solely yourself. Many times all the child needs is for you to break down the larger task into smaller more manageable tasks and for you to patiently talk your child through the completion of these smaller tasks.

6. Help your child reduce life stress.

When children are depressed, they have greater difficulty handling life activities in general. Cut back on activities that cause stress to increase and look for ways to help reduce stress in your child’s life.

7. Foster a positive home atmosphere.

Reduce or eliminate negative attitudes, language and conversations. Also avoid raised voices, passive aggressive behaviors and any form of physical violence in the home.

Make your home a safe haven for your child instead of an atmosphere that is ever volatile (in words, emotions or physically). Make it a calm environment that makes your child feel safe and secure mentally, emotionally and physically.

8. Help your child see the positive in life situations.

Point out the positives in a situation rather than the negatives. Help them see the bright side of any situation.

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Be a model of seeing the positive in life by speaking words that are uplifting, encouraging and positive. Resist the temptation to voice negative thoughts that come to mind as your child can feed off your emotions and words.

9. Believe your child when they talk about how they are feeling.

Listen to them patiently and take their words seriously. Do not discount or minimize their feelings. Express empathy and compassion when they do open up about their feelings. Help them utilize “I feel” statements in expressing their emotions.

10. Keep watch for suicidal behaviors.

Such behaviors include your child/teen researching this topic online, them giving away their possessions and a preoccupation with death.

Seek professional help immediately with the presentation of suicidal behaviors or thoughts. Keep this number on hand and use it when in doubt: National Suicide Prevention Lifeline Phone Number 1-800-273-8255.

11. Keep all prescriptions, alcohol, drugs and weapons locked and away from children and teens.

This is a given for all children, but even more imperative for children who are depressed as they have an increased likelihood to abuse drugs and alcohol. They also have an increased likelihood to attempt suicide. So keep weapons and tools such as ropes and knives that can used for suicide out of the child’s ability to use.

12. Spend quality one-on-one time with your child.

Make the time during your day, every day, to spend quality time with your child. You may have limited time and cannot provide an hour or more a day to dedicate to one-on-one time with your child, but you should provide a minimum of 20 minutes a day with your child spending quality one-on-one time together. Try the suggested activities listed in point #3.

13. Be an encouragement and supporter of your child.

Show love and not frustration or anger because of the situation and your child’s condition. Help keep your attitude positive so your child can also see the positive.

Provide daily words of affirmation that are not based on end results (such as a grade or a win) but instead praise the effort they put forth. If you praise the outcome, they will be disappointed when their efforts don’t pan out. If they are praised for their efforts regardless of the outcome, their confidence is built based upon something that they can control (the effort they put into things).

14. Help your child to live a healthy lifestyle.

Sleep is a very important factor in your child’s mood. Not getting enough sleep can cause an entire day to be upset. According to Sleep Aid Resource, children between the ages of 3 and 18 need between 8 and 12 hours of sleep each night:[3]

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    Ensure your child is eating a healthy and balanced diet, getting physical activity/exercise daily and plenty of sleep time.

    15. Help your child foster positive relationships and friendships with their peers.

    Set up play dates for your younger child and encourage older children to invite friends over to your home.

    16. Talk about bullying.

    It can be one of the causes of your child’s depression, so discuss their life outside of home and their interactions with their peers. Help them recognize bullying and discuss how to handle bullying properly.

    17. Help your child follow the treatment plan outlined by their doctor, counselor, psychologist or psychiatrist.

    Make sure you know the treatment plan that your child’s health care professional has outlined for child. This may include counseling session recommendations, medications and recommendations to follow through with in the home. Completing the plan will help provide optimal results for your child in the long run. A plan doesn’t work unless it is followed.

    18. Recognize that professional treatment takes time to show results.

    Don’t expect results for the first few weeks. It may take a month or longer, so be patient and understanding with your child.

    Depression in children is curable

    Depression in children can happen for a variety of reasons. It is quite treatable.

    Professional help is recommended if your child can possibly be diagnosed with a depressive episode. There are interventions that can be implemented in a professional setting, at home and at school. The key is having a plan of action to help your child.

    Ignoring the problem or hoping the depression will just go away is not a good plan. Treatment is imperative to curing depression in children.

    The first step is talking to your child’s paediatrician to get the ball rolling. He or she will refer you to specialists in your area that can help your child overcome and conquer their depression one day at a time. With you by their side, each step of the way you will get through it together and it is quite possible for your relationship with your child to be strengthened in the process as well. That can be your silver lining or positive outlook on the situation at hand.

    Featured photo credit: Unsplash via unsplash.com

    Reference

    [1] National Institute of Mental Health: Suicide
    [2] Ask Dr. Sears: It’s a Virtual World: Setting Practical Screen Time Limits
    [3] Sleep Aid Resource: Sleep Chart

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