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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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Published on November 30, 2018

Signs of Postnatal Depression And What to Do When It Strikes

Signs of Postnatal Depression And What to Do When It Strikes

Postpartum depression (PPD) strikes about 15% of women around childbirth.[1] Moreover, this mood disorder is estimated to affect 1% to 26% of new fathers.[2] The causes of which are thought to be linked to hormonal changes, genetics, previous mental illness and the obvious change in circumstance.

The stigma of mental health – with or without support from family members and health professionals – often deters women from seeking help for their PPD. In this article, I will show you 10 ways to begin overcoming PPD.

Symptoms of Postnatal Depression

Postnatal depression is defined as depressive disorder, beginning anytime within pregnancy up to the first year of the child’s life. The symptoms of post natal depression are the same as those of depression. In order to receive a diagnosis from the doctor, 5 symptoms must be shown over a two week period. The symptoms and criteria are:

  • Feelings of sadness, emptiness, or hopelessness, nearly every day, for most of the day or the observation of a depressed mood made by others
  • Loss of interest or pleasure in activities
  • Weight loss or decreased appetite
  • Changes in sleep patterns
  • Feelings of restlessness
  • Loss of energy
  • Feelings of worthlessness or guilt
  • Loss of concentration or increased indecisiveness
  • Recurrent thoughts of death, with or without plans of suicide
  • Lack of interest or pleasure in usual activities
  • Low libido
  • Fatigue, decreased energy and motivation
  • Poor self-care
  • Social withdrawal
  • Insomnia or excessive sleep
  • Diminished ability to make decisions and think clearly
  • Lack of concentration and poor memory
  • Fear that you can not care for the baby or fear of the baby
  • Worry about harming self, baby, or partner

Should you, a friend or your partner be showing any of these signs, I recommend you to seek medical advice.

Causes of Post Natal Depression

It is worth noting here that there is a difference between what is commonly known as ‘The Baby Blues’ and post natal depression.

Postpartum blues, commonly known as “baby blues,” is a transient postpartum mood disorder characterized by milder depressive symptoms than postpartum depression. This type of depression can occur in up to 80% of all mothers following delivery. The Baby Blues should clear within 14 days, if not it is likely an indicator of something more in depth.

It is not known exactly what causes post natal depression, however there are some correlating factors. These factors have a close correlation and haven’t been shown to cause PPD:

  • Prenatal depression or anxiety
  • A personal or family history of depression
  • Moderate to severe premenstrual symptoms
  • Stressful life events experienced during pregnancy
  • Maternity blues
  • Birth-related psychological trauma
  • Birth-related physical trauma
  • Previous stillbirth or miscarriage
  • Formula-feeding rather than breast-feeding
  • Cigarette smoking
  • Low self-esteem
  • Childcare or life stress
  • Low social support
  • Poor marital relationship or single marital status
  • Low socioeconomic status
  • Infant temperament problems/colic
  • Unplanned/unwanted pregnancy
  • Elevated prolactin levels
  • Oxytocin depletion

One of the strongest predictors of paternal PPD is having a partner who has PPD, with fathers developing PPD 50% of the time when their female partner has PPD. [3]

Ways to Overcome Post Natal Depression

1. Seek Medical Help

As knowledge of PPD grows, more and more physicians are becoming aware of the indicators and risk factors. This means that health care providers are looking for signs as early as their first prenatal care visit.

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If you are at risk, letting your provider know early in your pregnancy means that you’ll be given extra support and care throughout the process. It is best to seek treatment as soon as possible.

If it’s detected late or not at all, the condition may worsen. Experts have also found that children can be affected by a parent’s untreated PPD. Such children may be more prone to sleep disturbances, impaired cognitive development, insecurity, and frequent temper tantrums.

2. Therapy

This is the first line of defence against post natal depression and will commonly be prescribed alongside medication. Around 90% of post natal depression cases in women are treated with a combination of the two treatments.

You don’t need to do anything special to prepare. Your counselor will ask questions about your life, and it’s important you answer honestly. You won’t be judged for what you tell, and whatever you talk about will be just between the two of you. Your counselor will teach you how to look at some things differently, and how to change certain habits to help yourself feel better.

Therapy is personalized for everyone, but women in counselling for postpartum depression often discuss topics including; who you’re feeling, your behaviour, your actions and your life. (If you need immediate support please call the San Diego Access and Crisis Line at (888) 724-7240. The toll-free call is available 24 hours a day, seven days a week.)

3. Medication

There have been a few studies of medications for treating PPD, however, the sample sizes were small, thus evidence is generally weak.

Some evidence suggests that mothers with PPD will respond similarly to people with major depressive disorder. There is evidence which suggests that selective serotonin reuptake inhibitors (SSRIs) are effective treatment for PPD.

However, a recent study has found that adding sertraline, an SSRI, to psychotherapy does not appear to confer any additional benefit. Therefore, it is not completely clear which antidepressants are most effective for treatment of PPD.

There are currently no antidepressants that are FDA approved for use during lactation. Most antidepressants are excreted in breast milk. However, there are limited studies showing the effects and safety of these antidepressants on breastfed babies.

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4. Communication with Partner

Don’t blame yourself, your partner, close friends or relatives. Life is tough at this time, and tiredness and irritability can lead to quarrels.

‘Having a go’ at your partner can weaken your relationship when it needs to be at its strongest. It can be a huge relief to talk to someone understanding.

By spending time with your partner doing activities that you both enjoy, like going for a walk, can really help. This change of state, from moving location, can significantly elevate mood whilst providing ‘neutral ground’ in which to open up communication.

Be honest with your partner and show ways in which they can support you best through this time, even if it’s just talking or letting you have time to go take a shower.

5. Self Care and Rest

Don’t try to be ‘superwoman’. Try to do less and make sure that you don’t get over-tired. It’s common that women are the experts at ‘being busy’ and ‘doing it all’.

Rest whilst the baby is sleeping, and really take time to prioritise yourself. Throughout life, if you’re constantly giving out energy, you will be left feeling unbalanced. It’s important to become aware of one’s energy and making sure to give yourself energy first, before giving out is imperative.

Your body has just been through the trauma of the birth, which is very stressful. It therefore needs time to recover so taking time to yourself is important. Things as simple as a cup of tea, or shower or listening to music will really help.

6. Supplementation (especially DHA)

St John’s Wort is a herbal remedy available from chemists. There is evidence that it is effective in mild to moderate depression. It seems to work in much the same way as some antidepressants, but some people find that it has fewer side-effects.

One problem is that St John’s Wort can interfere with the way other medications work. If you are taking other medication, you should discuss it with your doctor. This is very important if you are taking the oral contraceptive pill. St John’s Wort might stop your pill working. This can lead to an unplanned pregnancy.

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It is also worth noting that fish oil (containing DHA) is being shown to correlate with lower instances of PPD. DHA consumption during pregnancy — at levels that are reasonably attained from foods — has the potential to decrease symptoms of postpartum depression,” conclude study researchers led by Michelle Price Judge, PhD, RD, a faculty member at the University of Connecticut School of Nursing.

7. Movement

Before starting any exercise program, you should consult with your doctor and find a fully qualified pre and post natal specialist. That being said, there is plenty of movement that can be done prior to ‘hitting the gym’, such as walking.

Not only does being outside positively benefit you by getting some fresh air and vitamin D. The same is said for your baby, who will likely sleep better once they’ve been outside. Exercise gets your endorphins going, which helps alleviate depression symptoms, It can also get you focused on something for yourself. In an analysis of data from 1996 to 2016, researchers discovered that moms who stayed physically active after birth experienced fewer depressive symptoms.[4] In contrast, one study found women who led a more sedentary lifestyle were, in general, more likely to experience postpartum depression in the first place. [5]

The type of workout doesn’t matter much. Yoga for pregnant women, stretching, and cardio are essentially equal in terms of making you feel better.

8. Socializing and Support Groups

Do go to local groups for new mothers or postnatal support groups. Your health visitor can tell you about groups in your area. You may not feel like going to these groups if your are depressed.

See if someone can go with you. You may find the support of other new mothers helpful. You may find some women who feel the same way as you do.

9. Accept Help

Some cultures believe that the symptoms of postpartum depression or similar illnesses can be avoided through protective rituals in the period after birth. Chinese women participate in a ritual that is known as “doing the month” (confinement) in which they spend the first 30 days after giving birth resting in bed, while the mother or mother-in-law takes care of domestic duties and childcare.

Whilst this may seem extreme, it’s worth noting that being able to accept help from your friends, partner and family can be extremely beneficial.

10. Avoid Smoking, Drink and Drugs

Which may seem common sense, however you may be tempted by the short term ‘fix’.

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Don’t use alcohol or drugs. They may make you feel better for a short time, but it doesn’t last. Alcohol and drugs can make depression worse. They are also bad for your physical health.

Final Thoughts

Most women will get better without any treatment within 3 to 6 months. One in four mothers with PND are still depressed when their child is one-year-old. However, this can mean a lot of suffering.

PND can spoil the experience of new motherhood. It can strain your relationship with your baby and partner. You may not look after your baby, or yourself, as well as you would when you are well.

PND can affect your child’s development and behaviour even after the depression has ended. So the shorter it lasts, the better.

Sometimes there is an obvious reason for PND, but not always. You may feel distressed, or guilty for feeling like this, as you expected to be happy about having a baby. However, PND can happen to anyone and it is not your fault.

It’s never too late to seek help. Even if you have been depressed for a while, you can get better. The help you need depends on how severe your illness is. Mild PND can be helped by increased support from family and friends.

Featured photo credit: Derek Thomson via unsplash.com

Reference

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