The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.
Other excellent resources about avoiding toxins during pregnancy
These are easy to read and understand and are beautifully presented.
Anyway, I think one thing that helped me was knowing that I was doing everything I could possibly do to encourage VBAC success. I did everything I could think of and everything that was suggested to me. I used a midwife practice, I read everything I could find on VBACs, I took a Bradley class, I wrote a really detailed birth plan, I arranged for a labor assistant to be present at the birth, I drank Red Raspberry Leaf tea and then took capsules too, I took Evening Primrose Oil orally starting at about 37 weeks and then masaged in onto my cervix daily from 38 1/2 weeks, I packed a labor bag w/ everything one could possibly ever need, etc.
I also faced the fact that w/ my last birth, I really had had the attitude that I didn't need to do anything to birth my baby. I had walked into the hospital without a birthplan expecting for those good people to remove my baby for me...and that's exactly what they did. This time I realized that I was the one who was responsible and I had to do it on my own...and that's pretty much what I did!
I wish you all the wonderful success that I had.
Author: Walton-D-L. Ludlow-D. Willis-D-C.
Title: Vaginal birth after cesarean section. Acceptance and outcome at a rural hospital.
Source: J-Reprod-Med. 1993 Sep. 38(9). P 716-8.
Journal Title: JOURNAL OF REPRODUCTIVE MEDICINE.
Abstract: A retrospective review of all pregnant women with a history
of cesarean section was conducted at an isolated military hospital. During
the two-year period 1988-1989, 62 patients were initially considered eligible
for attempting vaginal birth after cesarean section (VBAC). Seventy-nine
percent (49/62) of the patients initially requested a trial of labor, and
14 of them ultimately did not meet American College of Obstetricians and
Gynecologists criteria. Three patients reversed their decision late in
pregnancy. Eighty-eight percent (28/32) of those undergoing a trial of
labor delivered vaginally. The three patients with more than one prior
cesarean section all delivered vaginally. The four failures occurred in
patients who had a history of well-documented cephalopelvic disproportion.
Perinatal morbidity consisted of intrauterine fetal demise prior to the
onset of labor at 40 weeks' gestation. Maternal morbidity included postcesarean
endometritis (n = 1) and vaginal sidewall laceration (n = 1). These results
indicate that in a rural hospital VBAC was well accepted by patients and
was safe; however, further study is required.
Author: Brody-C-Z. Kosasa-T-S. Nakayama-R-T. Hale-R-W.
Title: Vaginal birth after cesarean section in Hawaii. Experience at Kapiolani Medical Center for Women and Children.
Source: Hawaii-Med-J. 1993 Feb. 52(2). P 38-42.
Journal Title: HAWAII MEDICAL JOURNAL.
Abstract: Medical records at Kapiolani Medical Center for Women and
Children were reviewed for cases that had a trial of labor subsequent to
prior cesarean section during the period January 1990 to July 1991. All
cases were > or = delivered 36 weeks' gestation. During the 19-month period,
356/483 or 73.5% cases with a trial of labor had successful vaginal births
after previous cesarean sections (VBAC). The majority of the others that
did not were due to failure of progression in labor. The incidence of scar
separation was 5/483 (1.04%). There were 5/483 neonates with Apgar scores
of < or = 6 at 5 minutes, giving a perinatal morbidity rate of 1.04%.
There were no maternal deaths. Oxytocin induction resulted in successful
VBAC in 30/47 (63.8%) cases. This study concludes that a trial of labor
for vaginal birth after cesarean section is well established at our institution.
In addition, the rates of successful VBAC, its complications and outcomes,
are comparable to national averages.
Author: Abitbol-M-M. Castillo-I. Taylor-U-B. Rochelson-B-L. Shmoys-
Title: Vaginal birth after cesarean section: the patient's point of view.
Source: Am-Fam-Physician. 1993 Jan. 47(1). P 129-34.
Journal Title: AMERICAN FAMILY PHYSICIAN.
Abstract: Advocacy of vaginal birth after cesarean section (VBAC) is
the current standard of care. We interviewed patients in our program about
their attitudes toward VBAC and cesarean section. The success rate in our
VBAC program is similar to rates reported in the literature (65 percent).
However, interviews with our patients revealed that 40 percent had no desire
to participate in the VBAC program, although they fulfilled the criteria
for eligibility. The main reasons given for declining a trial of VBAC were
the convenience of an elective cesarean section and fear of another prolonged,
painful and potentially dangerous labor. Thirty-two percent of patients
in whom VBAC was successful were dissatisfied with the experience and would
have preferred an elective cesarean section. The reasons patients gave
for attempting VBAC were different from the medical reasons proposed to
them. The main reasons given were a desire to deliver "naturally," a fear
of surgery and the concern that cesarean section might harm them or their
Author: Learman-L-A. Evertson-L-R. Shiboski-S.
Title: Predictors of repeat cesarean delivery after trial of labor: do any exist?
Source: J-Am-Coll-Surg. 1996 Mar. 182(3). P 257-62.
Journal Title: JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS.
Abstract: BACKGROUND: We evaluated the predictive value of risk factors
for repeat cesarean delivery identified in retrospective studies. STUDY
DESIGN: We identified 175 consecutive patients who underwent trial of labor
(TOL) and compared detailed admission, intrapartum, and postpartum characteristics
of those who required repeat cesarean delivery with those who had vaginal
births. We calculated relative risks, positive predictive values, and sensitivities
for potentially predictive admission characteristics. We also performed
multiple logistic regression and classification analyses. RESULTS: Ninety-five
percent of eligible patients underwent a TOL, and 85 percent of them delivered
vaginally. Patients who had labor induced and patients with high fetal
station on admission were significantly more likely to require repeat cesarean
section (relative risk [RR]=2.9 and 2.1; 95 percent confidence interval
[CI]=1.5 to 5.3, 1.1 to 4.2, respectively), but even these patients had
high rates of vaginal birth (67 percent and 75 percent, respectively).
A subgroup of patients who underwent labor induction and had large fetuses
(estimated weight 3,800 g or more) had a 75 percent risk of cesarean delivery
(RR=2.5, 95 percent CI=0.9 to 7.5). Multivariate models using different
combinations of admission characteristics could not correctly identify
which patients would require repeat cesarean delivery. CONCLUSIONS: Admission
characteristics with statistically significant risk ratios have low predictive
values because of the extremely low rate of repeat cesarean delivery in
this population. A larger series is needed to study TOL outcomes in patients
with large fetuses who are being induced. We conclude that until risk factors
with high predictive value for repeat cesarean delivery are identified,
all eligible patients should be encouraged to undergo a TOL.
This next one is not from the U.S., but from the Middle East.
Title: Vaginal birth after one previous caesarean section: a Jordanian experience.
Source: J-Obstet-Gynaecol. 1995 Feb. 21(1). P 9-12.
Journal Title: JOURNAL OF OBSTETRICS AND GYNAECOLOGY.
Abstract: In this prospective study, 119 women out of 135 (88%) of cases
delivered previously by one lower segment caesarean section at Princess
Basma Teaching Hospital in North Jordan, had a trial of labour, 103 out
of 119 women (86.6%) delivered vaginally. A high incidence of vaginal delivery
occurred in women originally delivered by caesarean section for cephalopelvic
disproportion (CPD) (69%). Repeat caesarean section was necessary only
in 13.4% of women mainly because of CPD and foetal distress. Labour was
induced for obstetric reason only. The incidence of scar rupture was very
low 1 of 119 cases (0.8%), with no maternal deaths. The duration of labour
doesn't differ significantly for those who had from those who never had
vaginal delivery before. So it is relatively safe to have a trial of labour
in patients delivered previously by one caesarean section.
Author: Weinstein-D. Benshushan-A. Tanos-V. Zilberstein-R. Rojansky-
Title: Predictive score for vaginal birth after cesarean section.
Source: Am-J-Obstet-Gynecol. 1996 Jan. 174(1 Pt 1). P 192-8.
Journal Title: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY.
Abstract: OBJECTIVE: Our purpose was to evaluate the relative weight
of the different variables that may influence the chances of vaginal birth
after one cesarean delivery, with the aim of developing a predictive score
for success of such a trial. STUDY DESIGN: In this retrospective study,
which covered a 10- year period (1981 to 1990), 471 women who attempted
vaginal birth at a level III university hospital after one abdominal delivery
were studied as to the subsequent delivery outcome. An attempt to identify
possible prognostic factors for success of such a trial was made. RESULTS:
A trial of labor was successful in 368 (78.1%) of women and 103 (21.9%)
had a repeat cesarean section. Variables of significant predictive value
were vaginal birth before cesarean section (odds ratio 1.8), malpresentation
(odds ratio 1.9), pregnancy-induced hypertension (odds ratio 2.3), and
Bishop score > or = 4 (odds ratio 6.0). Cephalopelvic disproportion and
failure to progress did not demonstrate a significant predictive value
(odds ratio 0.81) for success or failure in subsequent delivery. In fact,
63.8% of women with this indication have successfully undergone vaginal
delivery. Maternal age (odds ratio 0.9) had no bearing on vaginal delivery
success rates, whereas both macrosomia (odds ratio 0.2) and intrauterine
growth retardation tended to decrease the chances for vaginal birth after
cesarean section. CONCLUSIONS: A trial of labor after one cesarean section
should be encouraged in most women who are willing to attempt it, provided
no obstetric contraindication exists. A scoring system that may help to
identify women with a greater chance for vaginal delivery is proposed.
Author: Segal-S. Gemer-O. Zohav-E. Siani-M. Sassoon-E.
Title: Evaluation of breast stimulation for induction of labor in women with a prior cesarean section and in grandmultiparas.
Source: Acta-Obstet-Gynecol-Scand. 1995 Jan. 74(1). P 40-1.
Journal Title: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA.
Abstract: BACKGROUND. Information on the efficacy of breast stimulation
for inducing labor in grandmultiparas and in women with a previous cesarean
section with or without premature rupture of membranes is limited. METHODS.
Retrospective study of labor data from 135 women of grand multiparity or
those with a previous section with or without premature rupture of the
membranes in whom labor was induced by breast stimulation. RESULTS. The
success rate in achieving vaginal delivery was 84%. The duration of breast
stimulation, length of labor, vaginal delivery rate, and Apgar score did
not differ significantly among the four groups studied. CONCLUSION. Breast
stimulation in grandmultiparas and in women with a previous cesarean section
is efficacious and safe.
Author: Chattopadhyay-S-K. Sherbeeni-M-M. Anokute-C-C.
Title: Planned vaginal delivery after two previous caesarean sections [see comments]
Source: Br-J-Obstet-Gynaecol. 1994 Jun. 101(6). P 498-500.
Comment: Comment in: Br-J-Obstet-Gynaecol. 1995 Mar. 102(3). P 262-3.
Journal Title: BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY.
Abstract: OBJECTIVE: To determine the outcome of trial of labour after
two caesarean sections. DESIGN: Prospective observational study. SETTING:
Maternity and Children's Hospital, Riyadh, Saudi Arabia. SUBJECTS: Women
with two previous caesarean sections considered suitable for a trial of
vaginal delivery. MAIN OUTCOME MEASURES: The rates of vaginal delivery,
scar dehiscence, uterine rupture and associated complications among 115
women with two previous sections who underwent trial of labour were compared
with 1006 women with two previous sections who did not have a trial of
labour. RESULTS: Trial of vaginal delivery was requested by 230 out of
1136 women (20%) who had two previous caesarean sections. Of the 115 women
accepted for the trial, 103 (89%) were delivered vaginally. Labour started
spontaneously in 78 (68%) of the 115 women and was induced with prostaglandin
(PGE2) in the remaining 37. Augmentation of labour with oxytocin was required
in 32 (28%) of the trial labour group. There were no scar dehiscences among
the women delivered vaginally. There was one scar dehiscence and one woman
required hysterectomy after failed trial of labour, a frequency comparable
to the occurrence of these complications in women who did not have a trial
of labour. CONCLUSION: A trial of labour in selected patients with two
previous caesarean sections appears a reasonable option.
Author: Zheng-C-W. Hong-W. Lin-F-G.
Title: [Trial vaginal delivery for women with previous cesarean section]
Source: Chung-Hua-Fu-Chan-Ko-Tsa-Chih. 1994 Aug. 29(8). P 456-7, 508.
Journal Title: CHUNG-HUA FU CHAN KO TSA CHIH [CHINESE JOURNAL OF OBSTETRICS AND GYNECOLOGY].
Abstract: A retrospective analysis was made on 85 cases of trial labor
after previous cesarean section (CS) and compared with 100 primiparous
vaginal deliveries (as control) during the last 10 years. Oxytocin infusion
has been used in 61 trial cases to induce and/or to accelerate labor, and
valium, procaine and atropine administered during the labor process in
23 of them. 65 of the 85 cases (76.5%) successfully delivered through the
vagina (VD group), while 20 cases (23.5%) had repeat CS following failure
in trial labor (CS group), and 3 women had reatened uterine rupture. There
was 1 neonatal death in the VD trial labor group. No obvious difference
in the Apgar scores of newborns was found between the CS group and the
controls, and the duration of the labor process was much shorter in the
VD trial group than that in the primiparae (7.51 +/- 2.44 hrs vs. 9.10
+/- 3.75 hrs) (P < 0.01). This study indicated that following a previous
uneventful transverse lower segment cesarean section, trial labor should
be encouraged under supervision.
Author: Yasumizu-T. Nozawa-A. Kinoshita-T. Kato-J.
Title: Trial of vaginal birth following cesarean section for arrest disorders of labor: analysis of patients with well-documented medical records.
Source: Asia-Oceania-J-Obstet-Gynaecol. 1994 Dec. 20(4). P 407-13.
Journal Title: ASIA-OCEANIA JOURNAL OF OBSTETRICS AND GYNAECOLOGY.
Abstract: We elucidated several controversial problems surrounding the
vaginal trial in patients with prior abdominal delivery under the diagnosis
of failure to progress or cephalopelvic disproportion, by conducting a
prospective 6-year survey on the basis of patients who underwent prior
operation for arrest disorders of labor (ADL). Of 45 full-term women who
were defined as patients of prior ADL following a review of their past
medical records, 28 patients underwent trial of labor and 75% (21/28) were
successfully delivered of their infants vaginally. The seemingly critical
determinants as to whether or not a vaginal birth is successful are the
difference in neonatal weights between prior and current pregnancies as
well as the difference between maternal obstetric conjugate and fetal biparietal
diameter. These data suggest that patients who underwent prior cesarean
section for indications of ADL have a high chance of safely succeeding
if given a trial of labor under certain exclusionary criteria.
Author: Turnquest-M-A. James-T. Marcell-C. Spinnato-J-A.
Title: Vaginal birth after cesarean section in a university setting.
Source: J-Ky-Med-Assoc. 1994 Jun. 92(6). P 216-21.
Journal Title: JOURNAL OF THE KENTUCKY MEDICAL ASSOCIATION.
Abstract: Despite numerous reports in the literature almost universally
endorsing the safety of a trial of labor after a prior cesarean section,
it is used in only a small fraction of eligible patients. Our investigation,
conducted at the University of Louisville, examines the safety of such
a protocol. Two thousand seven hundred fifty-seven patients were delivered
during one year; 282 had a history of at least one prior cesarean section.
Of the 259 patients eligible, 218 (84%) underwent a trial of labor, and
168/218 (77%) were delivered vaginally. There were 6 cases of uterine dehiscence
and 1 uterine rupture. No hysterectomies were performed. Maternal morbidity
was significantly greater in the failed trial-of- labor group. There was
one perinatal death that was unrelated to a trial of labor. A previous
diagnosis of cephalopelvic disproportion or failure to progress did not
preclude a trial of labor, and 69% of these patients delivered vaginally.
Our data suggest that a trial of labor following one or more previous cesarean
sections is a safe option in a carefully selected population.
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