Tag: belly birth

After a Cesarean Birth

CBAC, HBAC, or VBAC?

April is Cesarean & VBAC Awareness month, and we know exactly how important it is to recognize both of these ways of giving birth. We know that nationally, around 1 in 3 births happen via cesarean section, and locally that holds fairly true according to the latest available data. While we don’t know the full extent as to WHY the planned hospital birth cesarean rate is so high, “It seems increasingly clear that anxiety and easy access to many medical procedures at hospital may lead to increased levels of intervention, which in turn may lead to further interventions and finally to unnecessary complications (Olsen & Clausen 2023).” All of that is big picture stuff though, and this post is really seeking to speak to the patient side of things. We celebrate ALL births, no matter how they happen. Let’s talk about 3 big areas where doulas can help after a cesarean birth.

Postpartum

The first 6 weeks after cesarean surgery can be challenging. Your body really needs to rest, but you have a newborn to take care of too. Maybe you’re still dealing with pain when you get home and timing medications, or your other kids really want to cuddle but you’re worried they might bust your incision. Lifting restrictions make moving baby, other kids, laundry baskets, etc challenging after a cesarean birth too. Hiring a postpartum doula, even when you didn’t plan to, can be a huge help to your family and your health in those first 6 weeks. Whether you get a doula or not, delegating should definitely be in your wheelhouse, because your body needs TIME to recover properly in this postpartum period at home.

Recovery

Physical recovery is what most people think about after a cesarean birth, and yes that is really important. After that initial 6 weeks, you may want to talk to your provider about physical therapy to work on scar mobilization and pelvic floor therapy too. Yes, even after having cesarean surgery your pelvic floor might need some work. Honestly, I don’t know why pelvic floor PT isn’t a standard referral after having a baby, but that is a blog for another day.

Mental recovery after a cesarean birth is something that we need to talk about more. I often find myself processing with my clients who’ve had cesarean surgery to talk about how things went, even if I wasn’t there for that birth. People react very differently to having cesarean surgery, and we truly believe all feelings are 100% valid. Mental recovery can be very easy for some and others struggle with it for a long time. Processing with a birth professional like a doula or with a therapist trained in birth trauma can be really validating and helpful for some people. This is a service we offer for clients all the time!

Next time

The big question that many people have after a cesarean birth is often, what should they do next time. Should you try for a VBAC (vaginal birth after cesarean), maybe an HBAC (home birth after cesarean), or maybe a planned CBAC (cesarean birth after cesarean) is for you. There is no one right answer that will work for everyone in this situation, and there are many many factors that go into making that decision. As doulas, we tend to nudge people to think about 4 things when they’re discussing what to do for their next birth:

  1. What were the factors that lead to your cesarean surgery?
  2. How do you feel about giving birth again?
  3. Is there information or other support that would be helpful for you to know when making this decision?
  4. How will you feel about your choice in 10 years?

Everyone answers those questions differently, and honestly there is no one right answer that will work for everyone. One thing we can say with the utmost certainty is that no matter what your choices are, our doulas will be there to support you 100% of the way. We’re working to try to help hospitals understand the value of having your doula in the operating room to support you during your surgical birth too, and will keep pushing for this here locally!

We’re very grateful that cesarean surgery exists, as we’ve seen it save lives. At the same time, we know that it is often over used. We LOVE that VBAC is a truly viable option here locally with many providers, and have seen some amazing HBAC births too. Birth is honestly just amazing in all the different ways it happens. If you’ve had a cesarean birth and want support in any of the above ways, don’t hesitate to reach out to us!

Our 2021 Local Statistics

Every year hospitals submit specific measurements to Leapfrog Group to see how the they are doing, and this year’s aren’t looking great. We like to check in on our local statistics to see how we are doing, and you can read last year’s local statistics if you’d like. In this table, the numbers in bold are from 2021 & those in parenthesis are from 2018.

Hospital NSTV Cesarean RateEarly Elective DeliveriesEpisiotomies
The Women’s Hospital
Newburgh, IN		27% (22.9%) 5.2% (1.7%)11.9% (14.8%)
Ascension St. Vincent Evansville23.5% (27.2%)0% (.8%)5.6%(6.8%)
Owensboro Health declined to respond (29.7%) declined to respond (1.4%) declined to respond (12.7% )
Memorial Hospital & Healthcare Center Jasper, IN17.5% (12.8%)4.5% (0.0%)7.4% (9.8%)
Daviess Community Hospital Washington, IN15.7% (15.2%)2.9% (1.9%)6.9% (13.1%)
Good Samaritan Hospital Vincennes, IN24.2% [20.7%]*3.8% [4.0%]*5.2% [14.2%]*
Deaconess Henderson Hospital27.6% (26.1%)2.5% (2.4%)2.6% (2.4%)
*numbers are from 2020, as we did not record the data for Good Samaritan Hospital in 2o18

Let’s take a moment to congratulate Ascension St. Vincent’s in Evansville for their success in reducing their overall NSTV cesarean section rate. Yes, there is room for improvement, but they are also the only local hospital that reported data and reduced their cesarean rate, as well as early elective deliveries AND episiotomies. Way to go StV!

Why does it matter?

The NSTV rate tells us the likelihood of a 1st time parent walking into a hospital with one head-down baby at 38+weeks gestation and walking out after having had major abdominal surgery to deliver that baby. This statistic doesn’t count surgical births for breech delivery or repeat cesareans or even first cesarean surgeries for your 3rd baby. From a population standpoint, we should be aiming to get that rate to between 10-15%, and huzzah Davies Community hospital is hovering right on top of that target. These reported NSTV local statistics have all gone in the wrong direction, and that matters for birthing families.

It matters because having one cesarean section increases the risks to you with each subsequent pregnancy. Is VBAC an option for you? Maybe, but only around 20% of people who have had a previous cesarean section will even attempt a Vaginal Birth After Cesarean, and then only if they can find a provider who is actually supportive. After a cesarean, your risk of things like placental accreta, increta, and percreta increase too. Surgical birth carries risk, and according to the evidence, we are doing surgery too often.

How can we change?

Hold OBs to their own standards. Yes, I mean us as consumers, but also hospitals and insurance companies too. ACOG gave some great ideas here, California has some ideas we could bring to the Midwest here & Dr. Neel Shah has been a leader in the call to figure out how to reduce cesareans. I have also read about hospitals publishing their own data publicly and privately nudging physicians to change by keeping them informed of their own professional statistics. I promise you that physicians have access to their personal statistics, whether they access them or choose to share them publicly (or even with patients) is another story all together. There has to be that push and pull if we are going to create true lasting change.

How can you reduce your own risk?

  1. Choose a place to give birth with a lower NSTV cesarean section rate. I know that insurance plays a huge factor in this, so that isn’t always an option for everyone. We do know that your greatest risk of needing cesarean surgery is the location of your delivery.
  2. Inform yourself! Know your options & be ready for what is to come for labor and delivery. You can’t prepare for all of it, but you can at least know what to expect and how the system can sometimes set you up to fail. Know what to watch for!
  3. Hire a doula! Having a doula on your team reduces the likelihood of needing cesarean surgery to birth your child. No, we can’t prevent all cesareans, especially because some of them are very necessary and honestly can be beautiful and healing too. We can promise that having a doula on your team will help you ask great questions of your care team and hopefully feel like the most important person in the room with all the decision-making power. (Because really, you are!)