Serious Side Effects for a Common Concern
Urinary tract infections are extremely common in women, and even more so among pregnant women. During the second and third trimesters of pregnancy, women are at an increased risk of developing a UTI. Treatment for this infection typically includes antibiotics, some of which can leave life-threatening adverse reactions for mom and baby.
A urinary tract infection is a bacterial infection of the urinary system. It develops when bacteria comes in contact with the urethra, ureters, bladder or kidneys. Women are more susceptible to UTIs because they have shorter urethras, providing bacteria quicker access to the bladder. Symptoms include:
- An intense urge to use the bathroom while your bladder is empty
- Burning sensation while urinating
- Lower back and abdominal pain
- Pelvic pain
- Bloody urine
- Fever or chills (which indicates the infection has spread to the kidneys)
Other contributors to urinary tract infections include sexual activity, a suppressed immune system, certain types of birth control, menopause and any other blockages in the urinary tract.
Treating Urinary Tract Infections During Pregnancy
Bacterial infections need to be treated with antibiotics to ensure the infection completely goes away. Although some antibiotics pose certain risks to unborn babies, not using an antibiotic to treat an infection could cause more harm. For that reason, doctors will recommend the safest option and most efficient treatment. Doctors even use the U.S. Food and Drug Administration’s list of Pharmaceutical Pregnancy Categories to help prescribe antibiotics that are safe to use during pregnancy.
These Pharmaceutical Pregnancy Categories rank in five letters — A, B, C, D and X — to indicate the level of safety of drugs for pregnant women. The most unsafe rankings are X and D, and are strongly advised against. The safest rankings are A and B. Drugs and antibiotics with a C ranking are somewhat safe, but it is important to know they may cause a level of risk. Some of the common antibiotics used during pregnancy include:
- Amoxicillin — B ranking
- Nitrofurantoin (Macrodantin) — B ranking
- Erythromycin — B ranking
- Ciproflaxacin (Cipro) — C ranking
Whenever taking antibiotics, it is important to only take what is prescribed. An excess of any drug, especially while pregnant, can prove to be dangerous to a mother’s health and her baby’s growth. Pregnant women are at an increased risk of developing bad reactions from drugs, specifically from fluoroquinolones. Studies have found these drugs can be toxic to a growing fetus, especially when taken in excess and not as a physician prescribed. Pregnant women taking fluoroquinolones should take only what is prescribed and with a level of caution.
How to Prevent UTIs
It is common for urinary tract infections to resurface over time. However, there are ways to reduce the likelihood of developing another infection. To prevent a UTI, you should:
- Wipe from front to back after using the bathroom.
- Stay hydrated! Increase your water intake while treating the infection, and drink at least 6 – 8 glasses of water regularly.
- Drink unsweetened cranberry juice, which can eliminate the presence of unwanted bacteria in the body.
- Avoid sexual activity while being treated for an infection.
- Wear cotton underwear to wick away moisture and maintain good hygiene habits.
Kiara Anthony earned her undergraduate degree in Mass Communications from Towson University, and her graduate degree in Communications from Trinity Washington University. She regularly contributes to Drugwatch.com, along with other publications.
My VBA1C Story.
So here it goes! I am a little late but I just finished up with school and having a newborn baby, and her being baby number two with a 5 year old boy at home has been quite the adjustment for me, but things are really coming along great and he is an amazing big brother to her!!! I had my amazing VBAC! I gotta say, my story is one of these stories you mommas trying for a VBAC MUST READ. I read stories like mine everyday during my pregnancy and they gave me so much encouragement. Because after what I had been through with my son, I honestly had a lot of doubt deep down. I was 17 when I got pregnant with him. I did not educate myself, I thought having a baby was nothin! I figured everyone else seemed to have a baby no problem, so why can’t I!? But as we all know birth can be very unpredictable. So as far as what happened with my son I will try to make a long story short, I went in for my last OB check up, which was a day before my due date and my blood pressure was extremely high so I got an ultra sound to check my fluids, everything seemed fine, but they did schedule me to be induced for June 13th. Hours after pitocin started I was making little progress even after they broke my water, ended up getting the epidural and after 24 hours of labor and 4 hours of pushing I ended up with a c-section. My son was posterior and was showing signs of stress. I just remember, after being told that I was going to be having a c-section, all I kept telling my sons father is “I feel like a failure, why can’t I do it!?” It was all very traumatizing. The anesthesiologist was a complete smart ass when came time to bring me in for the c-section, cuz I mean there was so much to joke about, right!? Afterward I was shaking so bad, I couldn’t hold my baby for nearly a half an hour after the c-section, not to mention I was so doped up on morphine and whatever else, I could barely function. I will say my son was absolutely perfect. 8 pounds 2 ounces and 21 ½ inches long, and very healthy. When the surgeon paid me a visit in the recovery room he informed be that I would HAVE to have the rest of my children a c-section in the future. I was highly upset. I was upset about the outcome of my birth, I felt everything had went wrong, and that I failed. Recovery was also very painful and lengthy!! But, my recent experience with my daughter was very healing. I feel empowered, strong, hopeful, blessed and so many other beautiful things that birth can possibly make you feel, but most importantly, I got my baby girl, who arrived healthy! And I was healthy! But enough rambling and on to the best part!
Ok, so I found out I was pregnant March 1st of this year. I guess I wouldn’t say it was planned, but we weren’t necessarily trying to prevent it. At first I was just like ok, I guess I’m going to have another c-section, that really sucks. But then my stubborn bitch side kicked in and I was like wait, no, they can’t make me do s***! I mean they can’t really force me to have surgery, I’m not doing it, I refuse. Most people thought I was crazy and I heard a lot of “oh but you have to” and “you’re not allowed” but I was determined. I was also determined to breastfeed which I was unsuccessful with my son as well. (which has been going great as well ) But anyway, I told my midwives that I really wanted to have this one natural and they told me I better go in when time to push or the more safer route would be to go to Spectrum, so that is what I planned to do. But then I was actually talking to my stepmom and I was explaining to her that I really wanted to have this one natural and she told me to look into hiring a doula. I heard of a doula, but didn’t really know what they did or anything about them. And then a few different people referred me to Faith Groesbeck. What a real kind hearted, and genuinely beautiful soul she is. So explaining to Faith what I wanted as far as birth and telling her about my first experience she suggested I go to Gerber Hospital in Fremont. I made my appointment to meet with the VBAC supportive provider for the first time and when I got there I couldn’t meet with her because she was in delivery with one of her patients. I could have rescheduled but I wasn’t going to be able to meet with her until closer to the end of my pregnancy. I was a little frustrated, understanding that things happen and it wasn’t her fault, I just decided I would go to Hackley. It’s right down the street from my house, yes they are not as VBAC supportive as I would like, but I just kept in mind that they can’t force me to do anything and that I CAN DO THIS. And I did eventually accept that, if I HAD to, if there were extenuating circumstances that required me a c-section, than I would because my daughter and my safety was number 1. But unless it came to that, I was determined to have my VBAC, at Hackley Hospital. No matter the risks (because I did an extensive amount of research and there were risks, yes, but very unlikely considering my circumstances. I was not high risk.), the paperwork I had to sign or the attitude that was given, because honestly, no one’s attitude was going to be bigger than mine, and paperwork..??? Give it here!
Other than all of the morning sickness I had at the beginning of my pregnancy, it went really well. I had a little bit of preterm labor scare at about 25 weeks, but was most likely due to lack of water. After that I would have Braxton-Hicks here and there but nothing to get to excited about. I was very patient up until the last 3 weeks of course. The anticipation really started killing me. On Halloween though, I lost part of my mucus plug. I did feel some excitement because I knew my body was making changes, but my due date was in 10 days so I also knew that it didn’t necessarily mean anything. I could have been pregnant for another 10 days, or longer!! So I went about my week as normal, but was definitely trying to get last few things done around the house in case she decided to come a little early. I was supposed to go visit my grandma in Grand Rapids that Saturday but I called her Friday because I was having Braxton-Hicks very consistently and had a feeling the baby would be here soon so I wanted to spend my weekend doing the final last touches to the house and the kids room. So Friday morning I woke up feeling fine, I had sex about 11 am-ish I think it was and about noon I started having the Braxton-Hicks. I went to the grocery store, came home and was hanging out with my son for a bit. He was supposed to spend that whole weekend with his dad but I didn’t want him to because I knew when the baby came he was going to go with his dad for about a week or so so I could recover a bit (my kids have different fathers, so you’re not confused lol) I didn’t want him to go though because I was sad that it was my last little bit of time left with him being my only child. So I told his dad that he could go that night but I wanted him back Saturday if I could so that I could soak up the time with him. So anyway, my son went with his father that evening and I got this huge burst of energy and cleaned everything. I mean everything. I also cooked dinner and made brownies! Meanwhile the contractions were starting to be more consistent and somewhat uncomfortable, they weren’t anything unbearable. It was about 9 pm when I noticed they were at about 10 minutes apart. I was not concerned though because I was still in minimal amount of pain. At 10:30 I lost the rest of my mucus plug and then I thought, ok my body is making more changes, GREAT! I think I may have somewhat been in denial. As I’m communicating with a good friend of mine, she’s all like “baby time, you’re going to have her tonight watch” and I’m all like yeah right, I wish! Although I did feel she was going to come soon I just didn’t think it was going to be that night or anything in the near-near future. Lol. Anyway I decided that jusssst in cassse the baby came that night I decided I Should take a shower and do my eyebrows lol. So it was about midnight and my daughter’s father showed up, he works second shift and gets out of work at 11. I told him I wasn’t sure, but I thought labor may be on its way. Lol denial at its finest…and at 12:30 I crashed really hard, so I laid down. I woke up at 2am from the sharp pain of a contraction. It wasn’t anything excruciating, but enough to wake me out of my sleep. I sat up and just dealt with them as they were a little uncomfortable. I texted my grandma and told her I thought I might be in labor. She called me immediately and asked me how far apart my contractions were and I told her about 3-4 minutes apart. She told me to go in, I told her that i didn’t want to go in because they would send me home. Yeah my contractions were close together but I wasn’t in that much pain yet. You would think if you were in real labor you would be in a great deal of pain right? So I called a close friend of mine and asked her how much pain she was in when she decided to go in and she said she was in so much pain but they kept sending her home. So Brandon, (my daughter’s father) said we should go in, and here I am like no I just don’t really want to get sent home… but with him and my grandma hounding me I said okay, I’ll go in, but watch me get sent home. Right before I left my house the heat turned up a notch! It was about 2:45 when we arrived to the hospital and when I got out of my truck I knew then it was real labor because I couldn’t walk through the contractions anymore. I could still talk, and was breathing through them, but they had me hunched over. They got me checked in and the Nurse checked me and said “okay they will probably be keeping you but the Doctor will be coming in shortly to check you again, now I understand you had a c-section with your first” I told her I wasn’t having a c-section and she says “Well, do you know our policy here at Hackley on VBAC’s?” Of course I went in there with my diehard attitude and I said, I know you guys are going to try to make me have a c-section and its not going to happen. She says “Well we aren’t going to make you do anything, but we do have to let you know the risks” Her name was Lauren, She was awesome and I will never forget her. I won’t forget any of those residents there that night. I also reminded all of the residents that I did not want an epidural or any other form of pain medication. The Doctor that came in, his name was Dr. Thomas Duncan, and right away he checked me and told me that they were going to do what they could to help me have a successful VBAC and went through the ricks with me and that it was going to be either him or Dr. Gale-Butto that would be helping me deliver. So wait am I dilated though? I asked him. “Yes, you’re dilated to 9, your water is bulging and I can feel baby’s head” he says. I got scared. It was really happening, I was about to have this baby, SOON! I was in a good amount of pain by this time but was breathing through the contractions and felt I was doing okay. I was scared mainly of what was going to come when my water broke. As they moved me to the room where things were getting much more intense I suddenly felt the urge to push and my water broke. They wanted me to hold off a little bit because I tested positive for group b strep but its kind of hard to hold off when your body is taking over. At one point i asked if it was too late for the epidural, and Lauren the sweet nurse I will never forget, encouraged me that i was so close and she believed i could do it without, along with my daughter’s father and one of my Doulas Elizabeth (Unfortunately Faith was not able to make it due to important life events in which I do not hold against her for we were communication the entire time, and she was very encouraging as well) . You can do it they kept telling me. One of the other nurses came in and wanted to check me again but I refused firmly. I was in so much pain by this point, hands feeling in my vagina is the last thing I wanted! And besides when they checked me last i was at a 9, what do you need to check again for!! I thought. I told them I wanted to push when I felt ready and that I wanted to listen to my body. So after my water broke I could not fight the urge to push any longer. It was time to start working that baby out! I would say when I first started pushing I didn’t feel like anything was happening but i was in all this pain and i felt like I was trying my hardest. So after a number of pushes and feeling like it would never end I got fed up with the pain and decided I would take in that deep breath and push with all my might. The harder I worked, the sooner I could hold my baby girl in my arms. It’s truly amazing what you body can do. When she was crowning I reached down and felt all of hair and it was almost relieving and it made me so happy to just be able to touch her and know it was almost over. Unfortunately there is no picture of me touching her head, but Brandon, her father did say the look on my face was priceless and he will never forget it. What’s also crazy is pushing your baby out, and wanting the pain to end so badly, but having the doctors tell you to push, but don’t push so hard, because they were working her head out and her shoulders. Lol That took some control, but had I not listened I may have tore worse than I did. But after pushing for an hour and enduring that great amount of pain that I had no idea I could handle, my beautiful baby girl arrived at 6:12 am weighing 6 pounds 8 ounces and 19 inches long, HEALTHY and PERFECT. It was instant relief and all I could think about was how perfect and beautiful she was and that I DID IT. She came out eyes wide open and sucking on the back of her hand. She was ready to nurse and latched on right away, no problem! I feel like a momma lion!!! I knew I could do it, and the encouragement i received from those around me helped so much!!! I will never forget the residents that helped me deliver at Hackley hospital. I am truly blessed and I hope you mommas who are trying for a VBAC get some encouragement from this, you CAN do it!!
“It’s so great to be around friends. The work we do is so hard.”
— Participant, 2016 Society of Family Planning’s North American Forum
In November of 2016, I had the honor of attending to the Society of Family Planning’s North American Forum, a life-changing experience, not so much because of what I learned, but because of what it made me feel. I knew this conference was going to be different from any other I had attended when I went to register and realized that I needed two personal references to even complete the online form.
This was heavy. It’s heavy because healthcare providers are risking their lives every day to provide comprehensive reproductive healthcare services to women. It’s heavy because by being in the presence of so many abortion doctors at one time, I was myself at risk for being murdered. Every conference attendee received a name badge, with a photograph that had to be scanned every time we entered the conference area. We were to turn off the location-finders on our electronic devices. We were to take off our name badges if we left the conference area. We were not to take photographs with other attendees and share them.
I’ve been to a lot of conferences before, but nothing with this level of security. One might think that I would be afraid for my own safety, but the measures taken were reassuring. A lot of people don’t understand the sacrifice people make to perform abortions. Often, it is the only work a doctor can do, due to stigma. This can result in social isolation. Going into the work is not taken lightly and is often the consequence of life-changing experiences, some of which were shared with tears and great conviction at the microphone. Sharing space with such brave people opened my heart to a small taste of what they experience daily. I can read about statistics and danger, but this experience brought me closer to a more personal understanding.
Doctors weren’t the only ones in attendance, though. There were also attorneys, researchers, academics, students, and advocates, but I think I was the only doula and childbirth educator present. I’ve shared a lot of the resources I gathered, but I haven’t written about some of the things that I learned that may be useful in my work. Here are some highlights:
- Catholic Healthcare:
- Although there are over 600 Catholic hospitals in the US, over 1/3 of women surveyed did not correctly identify the hospital where they sought care in terms of religious affiliation.
- Most women believe that hospitals should never be able to restrict care.
- Residents who graduate from programs at Catholic institutions report dissatisfaction with their training. Although they may not be able to provide abortions, they can still be taught how to do them, through online modules and off-site collaborations.
- Zika Virus:
- Many of the countries affected by Zika also have some of the most restrictive abortion laws in the world.
- Zika is not transmitted through breastmilk
- Men should wait 6 months after potential exposure before trying to conceive. Women should wait 8 weeks.
- We don’t yet know what the outcomes will be for infants who were exposed, but are “normal” at birth.
- Vertical (mother-to-fetus) transmission is less likely in the first trimester, due to the impermeability of the placenta, but if contracted, outcomes are worse. Later in the pregnancy, the fetus has a more mature immune system and the mother has transmitting immunity, so the outcomes are better.
- Affected countries are advising that women avoid pregnancy, without giving them access to contraception and abortion, which is an unfair and unreasonable expectation.
- Immediate Postpartum Long-Acting Reversible Contraception (LARC)
- LARCs can be inserted immediately postpartum.
- 50% of women ovulate and 60% resume sex before their 6-week postpartum visit
- Up to 35% of women never attend their postpartum visit
- Subdermal implants inserted 1 to 3 days postpartum have shown no negative impact on infant health or breastfeeding.
- Male Contraception
- There are 3 options for male contraception:
- Acceptability determines if men will use available options.
- Surveys show 44 – 83% of men would use, if available.
- Lowest acceptability is in Indonesia; highest is in Spain.
- Women play a role in acceptability – men are more likely to participate in studies when encouraged by their spouses.
- A barrier is that men don’t have a designated healthcare provider for birth control, but family planning clinics may be the most logical place for them to go.
- Methods exist, but are not yet labeled for use as male birth control.
- LARC methods exist for men, but are hindered by lack of precision and research.
- There is likely to be less of an environmental impact with male hormonal contraception methods than female methods because those are excreted into the waste-water and impact fish reproduction.
- There are potentially non-contraceptive benefits to male hormonal contraception, such as an increase in lean mass, decrease in fat mass and decrease in bone loss.
- There are 3 options for male contraception:
Overall, I left the conference feeling that the training of most doulas in family planning is inadequate. Doulas and childbirth educators play a role in reducing infant mortality, poor birth outcomes and perinatal mood disorders when we have knowledge of family planning to decrease unplanned pregnancies and increase interpregnancy intervals. We can also help educate clients about the wide range of birth control options and their potential impact on breastfeeding and future fertility. As a full-spectrum doula, it’s important to provide information and support that is respectful of the values of the families I serve, across the wide-range of reproductive health decisions they face.
Birth is amazing.
Birth is beautiful.
Birth is a journey.
Birth is unpredictable.
Birth is challenging.
Birth is unfair.
Birth is a miracle.
Birth is magical.
Birth is spiritual.
Birth is a rite of passage.
Birth is the only way.
Birth is inevitable.
— From a brainstorming exercise for my Birth Arts International (BAI) certification, “What is Birth?”
A couple of years back, I wrote a blog based on a question that often comes up in interviews, probably because some doula organizations include it in their list of questions to ask potential doulas: what is your philosophy on pregnancy and birth? What I wrote instead was my approach to my profession: evidence-based, trauma-informed and prevention focused. While I still hold to these practices, I think holistic, individualized care best defines my current practice.
When I was first asked this question, I felt like I knew the correct answer, which would be something like, “Pregnancy and childbirth are normal, healthy processes that are best left untampered with so nature can do its job.” The problem is, that’s not necessarily what I believe. In another blog, I addressed how the concept of “natural childbirth” isn’t inclusive enough to take into account couples for whom childbirth is a very technological process. Birth and pregnancy are only natural processes when circumstances and preferences allow.
After having supported a couple dozen families through birth, I feel like I have more of a grasp on what my philosophy actually is. Like my partner, Beth Singleton, who shares her approach to childbirth in another blog, I think the needs of the birthing person are paramount! I also think that my role is finding ways to balance their needs with the sometimes opposing needs of their support team, healthcare providers, partner and family.
As an advocate for reproductive justice, I identify as a full-spectrum doula, meaning I am here to support the pregnant person or parent as they make their choices, within the context of their sometimes complicated lives, regardless of the outcome. As I’ve written before, one’s reproductive decisions are impacted by many factors. There is no one right answer, but the best answer for that individual, at that time, in that situation.
There is a myth that doulas take the place of or override the needs of partners. Oftentimes, it is the partner or a family member who pays my fee. Regardless, the primary client is the pregnant person. When there is conflict, such as with the choice of a birthplace, it is still important to listen to all sides. Opinions that are in opposition to the desires of the birthing person are still valid and must be met with compassion and understanding. The process by which families overcome conflict around birth ideally strengthens them for the challenges of childrearing that lie ahead.
Which brings me to the choice of “Birth Quest” as my business name. Pregnancy, birth and parenting are unpredictable events. They force us to challenge our deeply held beliefs, our concepts of who we are and our purpose in life. Good support helps us to emerge stronger, more convicted and well-prepared for the lifelong journey of parenting and beyond. We are the heroes and heroines of our own stories that become woven into the foundations of the families we are creating.
I came into birth work with a good deal of dogma. Growing as a doula has been the process of shedding that in exchange for an openness and sense of wonder. Yes, doulas impact outcomes. This is a fact supported by research. I try to keep good track of the outcomes in my practice to see where I can improve my services to better support the needs of clients. My role is not to control variables, though, but to provide information and support along the journey.
Interested in attending childbirth education classes, but don’t have the time to research your options, travel outside of Muskegon or attend a full series?
Busy families like yours want to be able to make the best use of their valuable time when expecting a new addition. That’s why Birth Quest offers a la cart classes so that you can seek out knowledge according to your unique interests and circumstances. I have taught a wide variety of classes privately, in group settings, for non-profit organizations, and as a guest presenter in classrooms. Since 2014, I have taught classes in the following settings (places in italics were as a volunteer):
- Muskegon Area Career Tech Center
- Ross Medical
- Orchard View High School
- Covenant Academy
- The LGBTQ Center of Muskegon
- On the Path Yoga
- The Red Lotus Gallery
Please contact me if you would like to host a class!
Are you having trouble deciding which classes to attend? Check out the class descriptions below:
- Choices in Childbirth: Providers and Settings — Did you know that the choice of where and with whom to give birth best predictor how it will turn out? The purpose of this class is to educate you about all of your choices are so that you can give birth where you feel safest and the most supported.
- Self-Care for Your Changing Body — This class is for those who are motivated to optimize their health during pregnancy through diet, movement and tending to their emotional needs. Strategies for alleviating common pregnancy discomforts will also be shared.
- Holistic Pregnancy Care Options — Many families are turning to less invasive and more natural solutions during pregnancy and birth. This class will look at several different complementary and alternative medicine options, along with where to find practitioners in the Muskegon area.
- Birth Plans: What Parents Need to Know — There sure are a lot of choices to be made when having a baby! You will leave this class confident, knowing what the available research says about birth plans, staff responses and birth outcomes. Parents will be provided with multiple templates for creating a birth plan, as well as advice for forgoing a birth plan altogether. Whatever families decide, they will learn all the key decision-making points from early labor to common newborn procedures and everything in between.
- Labor & Delivery: Prepared & Informed — Birth is unpredictable, full of unexpected twists and turns, making it something families anticipate with both excitement and apprehension. Highlights of this class include indications for, risks and benefits of and how to prevent common interventions, such as inductions, episiotomy and cesarean. Childbirth education does not guarantee an outcome, but it can lead to empowerment: knowledge is power!
- Essentials of Labor Support: What Birthing People Need — This class is for the birthing person and whoever they choose to support them during labor and delivery, including spouses, partners, friends and family members. Topics include communication skills, practicing massage comfort techniques and so much more!
- Pain-Coping Strategies: A Smorgasbord of Options — Pain relief during labor is a primary concern for many pregnant people. Some believe that they must choose between no pain relief or an epidural. Fortunately, we’ve come a long way since the days of a one-size-fits-all approach. We will explore a full spectrum of both pharmaceutical and natural ways to lessen and cope with the pain of childbirth.
- Postpartum Wellness: The Fourth Trimester — This class is focused on the physical and emotional health of parents after a birth. We will cover recovery from a vaginal or a cesarean birth, movement, nutrition and mental health with lots of resources for further exploration. This class is appropriate for any expectant or new parent.
- Newborn Care — Babies aren’t born with an instruction manual, but the good news is that you are the expert on caring for your baby! We will cover what to expect from newborns in terms of appearance and behavior, as well as bonding, development, diapering, bathing, safe sleep and more!
- Breastfeed Successfully with Knowledge & Support — This class is for anyone interested in learning more about the benefits of breastfeeding how it works, and how to avoid common pitfalls, as well as community resources to support breastfeeding families.
- Childbirth After Cesarean: Making Informed Decisions — With about 1/3 of West Michigan moms delivering their babies via cesarean, many are faced with limited future childbearing options. This class seeks to inform and empower families before and during pregnancy to make the best decisions for themselves and their families.
- Introduction to Birth Work: Doulas & Childbirth Educators — This class explains possible career paths for doulas and childbirth educators, what they do and how they positively impact birth outcomes. The presentation concludes with a sample childbirth education class.
Classes can be tailored to suit the needs of any setting or population, like youth, maternal and infant health professionals, homeless shelters, or places of worship. Presentations can also be developed to cover other specific topics, like pregnancy complications, anger management during pregnancy, substance abuse prevention or parenting. What topics would you like to see Birth Quest offer?
In March of 2014, the American College of Obstetricians and Gynecologists (ACOG) released a statement called “Safe Prevention of the Primary Cesarean Delivery.” In that statement, they outline some ways to decrease cesareans, including:
- Letting early (latent) labor progress without time limits.
- Changing the definition of active labor from 4 cm to 6 cm.
- Not diagnosing “failure to progress” (no adequate contraction or cervical change) during active labor before four hours without oxytocin and six hours with.
- Letting those who have delivered vaginally before to push for at least two hours, three hours if they haven’t, and even longer in some situations, like an epidural or posterior baby, before a cesarean is recommended.
- Using instrumental delivery, for example vacuum extraction or forceps, to help with vaginal delivery and avoid cesarean. This includes ensuring new doctors are learning these skills.
- Counseling patients to avoid gaining over the recommended amount of weight during pregnancy.
I became a doula the year these changes were implemented, although I had attended several births before my career change. It wasn’t until I participated in an online webinar through GOLD Learning’s Online Symposium on Childbirth Education with Penny Simkin, entitled, “The Tipping Point(s) in Childbirth Education & the Consequences of Ignorance,” that I really understood how these changes were affecting my practice as a birth worker and impacting the experiences of the clients I served.
According to Simkin, time and patience are allies of the parent and baby, but our job as childbirth educators, doulas and advocates, is to convince birthing women that these things are important! Since “Longer labors are harder on women,” Simkin says, “motivation, incentive and know-how are essential” and that “when people understand why and how to avoid a c-section and are assisted along the way, the odds of success improve.”
When I consider my recent experience as a childbirth educator and doula, her wisdom really resonates with me. Birthing people are often sent home, multiple times, after being told they are not yet in “active labor,” which can be discouraging when their bodies are giving a different message. Preparing them for this possibility begins with educating them about the high rates of cesareans and how ACOG guidelines defining 6 as the new 4 for active labor is a positive change to help them achieve the birth they desire. Next, providing strategies for staying home as long as possible can put them in a better mindset for the long-haul ahead of them.
Along with realistic birth preparation, childbirth educators and doulas can provide strategies that can be used during labor to help increase endurance: nourishment, movement, relaxation and rest. Encouragement is also key, so believe in the birthing person and their body’s ability to birth from beginning to end and let them know you do!
If you are planning a pregnancy after a cesarean, you may be considering a vaginal birth after cesarean, or VBAC. For people in Muskegon and along the West Michigan lakeshore, you may not know anyone who has ever chosen this option, so finding support is key. I have compiled this list of VBAC resources to help you educate yourself about your choices.
Research shows that having a doula reduces the risk of having a cesarean and increases the chances of a successful VBAC. As with a primary cesarean, the biggest factors to influence the success of a planned VBAC are the provider and facility. Doulas are aware of all of available options, so find one early in your pregnancy.
Only 6% of birthing families hire a doula, so it may be hard to start your search. When asked why they chose a specific doula, most people say that they clicked, or had a good vibe. For this reason, most doulas, including myself, offer a free consultation in your home or the location of your choice.
Resources for finding doulas in your area include your healthcare provider, DoulaMatch.net, birthingnaturally.net and Doulas.com. The Facebook page for the Lakeshore Doula Network includes a list of doulas that practice in the greater Muskegon area.
International Cesarean Awareness Network (ICAN)
ICAN of Grand Rapids, the nearest chapter, supports pregnant people who are looking to avoid an unnecessary cesarean, those who are recovering from cesarean surgery and those who are planning to have a VBAC. People gather once a month to share their stories, increase their knowledge and get support.
As a doula who has only had vaginal births, I attended a couple of meetings to listen and learn more about how to support my clients who have cesareans and are planning VBACs. While the focus of birth is often on the physical health of the birthing person and infant(s), ICAN is a nonjudgmental space to get support for the emotional aspects of birth. Knowing they are not alone and being able to tell one’s story is often a first step toward healing.
Here are some of my favorite resources for learning more about VBAC:
- VBAC Education Project (VEP): VEP was created by Nicette Jukelevics, MA, ICCE to “empower women to make their own decisions about how they want to give birth after a cesarean and to provide VBAC-friendly birth professionals and caregivers with the tools and resources to support them.” All materials are downloadable for free. I had the pleasure of meeting Nicette at the 2016 ICAN conference and she was very passionate about getting her materials to people who can benefit from them. I’ve used VEP materials in my own teaching and am grateful for such an accessible resource!
- Vaginal Birth After Cesarean (VBAC): Informed and Ready: This is a Lamaze childbirth education online class for parents. Curious about the content for my own teaching, I paid the $29.95 and watched it myself back in May of 2015. It covers the emotional aspects of a cesarean, factors affecting VBAC success, the risks of repeat cesareans for moms and babies, the risks of VBAC, how to choose a provider, resources for parents and more! Not a bad deal to receive guidance in childbirth after cesarean from the comfort of your own home.
- VBACFacts.com: Jen Kamel founded this website, which provides “realistic, powerful, non-biased, research-based, trustworthy and balanced” information on VBAC for parents and professionals. Her online course for parents, “The Truth About VBAC for Families,” is $299 and includes many resources. Jen Kamel is more than an authority on VBACs, she is a strong advocate for childbirth choices! Her current work helping to reverse hospital VBAC bans will positively impact many.
Women in Muskegon and elsewhere along the West Michigan lakeshore have several options for childbirth after cesarean. What are some of these options?
The majority of women in Muskegon County who have a prior cesarean have a repeat cesarean section (RCS). This may be because they decide this is the safest option for them based on their medical history, while others prefer the certainty and convenience of scheduling their birth. Other times, women don’t realize that they have other options or don’t have the support to access them.
Vaginal Birth After Cesarean (VBAC)
I’ve heard Muskegon birthing people being prepped for surgery be told that they can deliver vaginally in the future, but that they would have to go to a Grand Rapids hospital. That’s only part of the story. While currently, all three of the hospitals in Grand Rapids, Spectrum Health Butterworth, Metro and Mercy Health St. Mary’s, offer VBAC, distance makes this option a challenge for many people. Holland Hospital also offers VBAC as an option. Others are intimidated by the prospect of receiving prenatal care and delivering with a large practice and facility, which feels impersonal compared to the care they are accustomed to in their community. Despite the challenges, some Muskegon people will travel out-of-county for their VBAC.
Another option that appeals to some families is to deliver in a community hospital that has a VBAC ban, or policies that discourage VBAC, but is known to have supportive providers. Dr. Michele and her colleagues at Spectrum Health Gerber Memorial have an excellent reputation for supporting those who choose to have a VBAC. Others receive their prenatal care locally, put off scheduling a RCS or do not show to appointments, with the plan to show up in labor at their local hospital. Local community hospitals include Mercy Health Hackley in Muskegon and North Ottawa Community Hospital (NOCH) in Grand Haven. I have heard of people having VBACs at Hackley, despite the ban, but not at NOCH.
Free-standing birth centers are an option for women who want to deliver with a midwife in a home-like atmosphere outside of, but close to, a hospital. There is some evidence that choosing midwifery care through a free-standing birth center increases VBAC success rates. There are two possibilities for this option in West Michigan: Midwifery Matters and Simply Born Birth House. Birth centers have criteria they use to screen women to see if they are good candidates for this type of care. If this is something you are considering, I recommend scheduling a consultation before pregnancy to learn more.
The final option is to plan a home birth after cesarean, or HBAC. In the event of a rare complication, like a uterine rupture, this may not be the safest option, but some people are willing to take the risk to birth on their terms, in the privacy of their own home, with a provider who believes in their body’s ability to birth. As with birth centers, home birth midwives have criteria for screening clients who are candidates for HBAC. You may have to interview several in order to find the right one for you.
As with any birth, there are many decisions to be made. Since providers vary a great deal in their support of VBAC, it isn’t a bad idea to do some research prior to your next pregnancy. A provider may also have good advice to increase your chance of having a successful VBAC, like the amount of time to wait between pregnancies and how to optimize your health.
While those in Muskegon and along the lakeshore may not have all of the options available to birthing people in large, metropolitan areas, they do have possibilities. Knowing what those are is the first step to choosing the course of care best for you and your family.
Healthy People 2020 (HP2020) is a national initiative through the Centers for Disease Control (CDC) to improve the health of all Americans by creating targets for improving leading health indicators in a specified time frame. Increasing vaginal births after cesarean (VBAC) for low-risk women is one of those indicators.
There is no way to measure progress on these outcomes without data. Data is essential to any process to improve health. If we don’t know where we’re starting, we have no idea if our interventions are having the intended impact. For this reason, the Michigan Department of Health and Human Services (MDHHS) started collecting and sharing information by county on the percentage of women with a prior cesarean who have a repeat cesarean (to calculate the opposite, or percentage of women with a prior cesarean who did not have a repeat cesarean, subtract the percentage given from 100).
Not surprisingly, when compared to surrounding counties, Muskegon ranks last. In fact, in 2014, the most recent year for which data is available, only 16 women in Muskegon had a VBAC! This was not always the case. When women were encouraged to plan VBACs and deliver at local hospitals in 1999, this number was 83! VBAC bans make a difference.
Kent County leads West Michigan in the percentage of women having VBACS. When it comes to options, Kent County women can choose from three hospitals, Metro, Spectrum Health Butterworth and Mercy Health St. Mary’s. All of these hospitals allow VBACs.
Why does this matter? Why should women be concerned about their access to options for giving birth after a cesarean? The truth is that laboring and attempting a VBAC is less risky for most women than having major surgery. Family size also matters. The risks decrease with each successful VBAC and increase with each subsequent cesarean.
While many providers inform women of the risk of uterine rupture when attempting a VBAC, women are almost never informed of the risks of repeated cesarean surgeries. Every year in the month of October, the International Cesarean Awareness Network (ICAN) works to educate women about one of those risks: accreta. Accreta is a condition in which the placenta attaches too deeply into the uterine wall. According to their website, in the presence of placenta previa, the risk of accreta is 3% with the first repeat cesarean and increases to 67% for fifth or higher. Seven percent of women with placenta accreta will die from excess blood loss. Many women are encouraged to have a repeat cesarean without ever being informed of the risk of accreta. In fact, many women first learn about what accreta is when they are diagnosed with it!
When I speak with women in Muskegon about what influences their decision on how to birth after a cesarean, most tell me that the distance to travel to a hospital without a VBAC ban is just too far. They don’t want to travel for care or risk having a baby in their car. Some don’t have reliable transportation or gas money to make it to a hospital that allows VBAC. Most women want to give birth in their own community with the providers they know and trust. This is where their support system is and they don’t want to accept additional challenges by having a baby far from home.
One of the roles of doulas is educating the public on their options. If you are pregnant or planning a pregnancy after a prior cesarean, hiring a doula may be a first step in learning about your available options.
At Birth Quest, we’d like to hear from you! Are you a Muskegon woman who planned a VBAC? If you chose a repeat cesarean, what were the factors that influenced your decision? Your experiences may help another woman in a similar situation. Thanks for sharing!
In a prior blog, I wrote about how North Ottawa Community Hospital (NOCH) closed their midwifery practice in 2014. At that time, I contacted both federally qualified health centers (FQHCs) in Muskegon to ask them if they would be willing to have me interview them to help spread the word to expectant women in the area about their remaining options. Hackley Community Care (HCC) got back with me and we were able to videotape an interview with their collaborating physician, Dr. Danielle Koestner.
I have been at several births with the HCC midwives and have always been impressed by the way they respected and supported the wishes of my clients. The good relationship we had benefited our mutual clients because we were able to communicate concerns to better coordinate care.
When I learned that the HCC midwives were going to stop catching babies, my initial response was, “Not again!” Like others, I am still upset about losing the option of midwife-attended deliveries at NOCH. Still, I wanted to wait and find out more information. Earlier this week, I received the official letter from HCC, stating that the midwives were going to continue to provide pre- and post-natal care and that they were officially certified as a Centering Pregnancy site. Now, however, the obstetric laborist and residents at Mercy Health Hackley would be in charge of their pregnant patients’ labor and deliveries.
The laborist comes with a wealth of knowledge and experience. While many women include avoiding residents in their birth plans, I have found them to be on top of the latest research, open to patient preferences and supportive of evidence-based care. For some women, this will be an acceptable option. During their prenatal care, they will benefit from an evidence-based group prenatal care model, the individualized care characteristic of midwives and access to a host of other services offered on-site. However, for women specifically looking to benefit from the better outcomes research shows continuous care from a midwife during labor and delivery offers, this change will be unacceptable. The research shows that interventions are lower and outcomes improve when midwives provide care throughout the pregnancy, labor and delivery.
For women who seek a midwife to provide their prenatal care and attend their birth, Muskegon Family Care (MFC), Muskegon’s other FQHC with a midwifery program, recently hired new midwives and are now fully staffed. In July, I had the pleasure of meeting with one of them, Katie Van Heck, CNM, to discuss how to improve their services by increasing their patients’ access to doulas. I now have a couple of clients who are seeing the midwives there for care and I am excited to work more with this practice in the future!
If you live along the West Michigan lakeshore and you wish to deliver in a hospital, with a Certified Nurse Midwife (CNM), the only midwives who can practice in Michigan hospitals at this time, these are some of your remaining options:
- Muskegon Family Care – With four midwives on staff, this practice is located in a federally qualified health center in Muskegon Heights. This means they primarily serve low-income people, but they can serve anyone.
- Spectrum Health Gerber Memorial Women’s Health – The legendary Susan Wente, CNM, DrPH, who caught my own daughter, works with three other physicians. While there is no guarantee that the midwife will be on-call when you go into labor, many families are willing to drive further to have their baby at Gerber due to the practice’s reputation for being open and accommodating to natural birth.
- Midwifery Services at Advanced Women’s Ob/Gyn – If Muskegon-area women are willing to travel to Spectrum Health Butterworth in Grand Rapids to deliver, this private midwifery practice has an 6% c-section rate, which speaks for itself.
What will be the next news for midwifery options along the lakeshore? Hopefully, something positive, like a new private practice or free-standing birth center opening up!
Did you have your baby with a midwife in a hospital? Please share your experiences in the comments!
Sandall, Jane, et al. “Midwife‐led continuity models versus other models of care for childbearing women.” The Cochrane Library (2016).
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