3/3 succesful VBACs!

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Wow, I have amazing clients! I am so grateful to serve as a midwife in my community. This year I have had three moms with a prior cesarean section join my care. These courageous healthy women wanted to make their own choices and have a different birth story this time around. I’m happy to report that all three had successful vaginal births after cesarean (VBACs)! I am proud and so happy for these moms and babies. Of course having healthy safe outcomes is more important than route of delivery, but when a VBAC is a safe choice it can be empowering and victorious. What a joy and honor it’s been to witness these moms giving birth! I have a special place in my heart for VBAC moms.

My love of VBACs began when I was an apprentice with Madrona Bourdeau in Portland. I went to a number of VBACs in this early training, and I really came to appreciate the courage and beauty of mothers who choose to try for a vaginal birth at home after a cesarean. While not every attempted VBAC is successful, the attempt is an act of courage, dedication and love.

The World Health Organization suggests an ideal cesarean rate of 10-15%. In our country, around 32% of babies are born by cesarean section. Sadly this high cesarean rate comes with consequences. Babies born by cesarean section are shown to have negative longterm effects, such as decreased immune function and increased risk of childhood diabetes, asthma, obesity and autism spectrum disorders. Repeat cesareans are sometimes the right choice, but I find it appalling that many mothers are not even given a choice. Far too many care providers don’t offer VBACs and instead just schedule repeat cesareans. Even when moms are given a choice, it is often accompanied by scary one sided statistics. This is not real informed choice.

In 2021, the VBAC rate in the United States rose to a whopping 14.2%. This would imply that VBACs are either incredibly difficult or extremely risky. While VBAC’s can be hard, most (around 70%) of folks who attempt them are successful. VBAC’s do slightly increase the risk of several serious complications, mainly uterine rupture and the placenta growing into the previous uterine scar. While these risks are real, they are still quite low (the risk of uterine rupture with VBAC is 0.47%, and avoiding labor induction further reduces this risk.) And the risks of a repeat cesarean are real as well. In fact, the risk of maternal death is higher with an elected cesarean than it is with a VBAC. If a mother wants to have more children in the future, a VBAC can also avoid the risks associated with multiple cesareans. Evidence supports VBAC as a safe and doable choice. Mothers deserve to choose!

I am passionate about informed choice. Some things increase the risk of trying for a VBAC, such as labor induction. Other factors can reduce your risk, such as your scar location. Evidence Based Birth has a great VBAC page. The National Library of Medicine has a great research article on the affects of cesarean sections and another on the risks to mom and baby of attempted VBAC vs repeat cesarean. If you are unsure if VBAC (or any birth choice) is right for you, ask questions, do your research, and trust your intuition. The choice is yours!

Sources:

1 Słabuszewska-Jóźwiak, Aneta et al. “Pediatrics Consequences of Caesarean Section-A Systematic Review and Meta-Analysis.” International journal of environmental research and public health vol. 17,21 8031. 31 Oct. 2020, doi:10.3390/ijerph17218031

2 https://www.cdc.gov/nchs/data/databriefs/db442.pdf

3 https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/vbac/art-20044869

4 Cheng, Yvonne W et al. “Delivery after prior cesarean: maternal morbidity and mortality.” Clinics in perinatology vol. 38,2 (2011): 297-309. doi:10.1016/j.clp.2011.03.012

5 Evidence Based Birth. https://evidencebasedbirth.com/ebb-113-the-evidence-on-vbac/

Midwifery during COVID-19: moving from fear into trust

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What an interesting time to be a home birth midwife! I am grateful, as always, to offer safe home birth to low risk women. Right now this is even more pertinent, as home birth with a midwife can reduce the risk of potential covid-19 exposure in the hospital. Also, hospitals may be facing a crisis of overwhelm due to covid-19 patients in the coming weeks/months and so may have less resources for laboring women. This covid-19 pandemic is real, and it is causing a lot of fear around the world.

Yet in my experience fear makes birth longer and more painful. Birth unfolds most easily when women trust their bodies and feel safe. Fear closes us. Trust helps us open. Where do you feel safe to trust your body and open to your baby?

Are you pregnant and considering home birth? Give me a call and we can discuss if it is a safe option for you. Be well!

Why Homebirth? Part 1: Hormones

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Birth is vital, raw, and powerful. The natural birthing process involves a cascade of hormones that strengthen contractions, deepen mother-infant bonding, and bring on sensations of euphoria. Routine medical practices, from Pitocin labor augmentation to unfamiliar people and bright lights, can interfere with these natural hormones. It is much easier to support the natural hormones of birth in the comfort of your home.

Under ideal birthing conditions, the birthing mother is flooded with oxytocin, the hormone of love, trust, and attraction. During labor, there is a positive feedback response in which high levels of oxytocin promote a further increase in oxytocin levels. This oxytocin creates effective uterine surges. As these surges intensify, the body releases Beta-endorphins, which are feel good hormonal opiates we are familiar with from intense exercise. Beta endorphins can help mom experience the primal intensity of birthing as euphoric, and wonderfully alter her birthing experience. As birth gets nearer, mom’s Beta-endorphins and oxytocin levels soar. The highest levels of oxytocin a woman ever has are present at the end of labor through birth and immediately after. This means that during birth, mom and baby have the opportunity to feel deep love and trust greater than any other time in life.

Synthetic Pitocin interferes with the natural hormonal cascade in several ways. First of all, when a mom receives Pitocin, this synthetic hormone fills her oxytocin receptor cites, blocking her natural oxytocin. While Pitocin effectively strengthens and brings on uterine contractions, it does not cause sensations of love and trust like oxytocin. Pitocin also does not stimulate the release of Beta-endorphins, so laboring mothers often request pharmaceutical pain relief.

Supporting the hormonal cascade of birth is fairly instinctual. Mammals do this by finding a safe, dark, quiet, private space to birth. For a woman this equates to having trusted caregivers in a familiar and safe setting, where mom can fully relax into her birth.

Maternal hormones respond to stimuli from the environment, among other things. Imagine a laboring cat in her private dark corner. Then imagine wheeling her away to a veterinary clinic, hooking her up to multiple machines and shining bright lights on her private parts! When a laboring animal is disrupted, her labor will stop. Women have a similar hormonal response. Unless birth is imminent, stress hormones slow or stall labor, and also increase maternal pain. So for a long, slow, painful birth, choose an unfamiliar, brightly lit, loud birth setting with caregivers you have never met! If you’d rather experience gentle birth, overwhelming love, and euphoria, support the natural birthing hormones by choosing a familiar environment (like your own home) with caregivers you know and trust.

Micaela Gauss, CPM, LDM

Micaela gets married!

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You may notice that my name has changed to Micaela Gauss. In July 2017, I married Peter Gauss under a cedar tree in our back yard. We had a small circle of friends and family here to witness our wedding and share the joy of our connection. We are quite happily married, and I finally took all the steps necessary to change my name to Micaela Gauss on my midwifery license. I'm still me, but with the added privilege of being supported by an amazing husband, Peter.

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Kayla gives birth to Kingsley: A Birth Story

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    Kayla trusts birth, her body, and her instincts. This was clear the first time I spoke with her, and remained true throughout her pregnancy and birth.

    As Kingsley grew, and Kayla’s belly with it, my ears heard a strong heart beat and my hands felt a growing healthy baby. All was well, and we were ready for a home birth. Kingsley’s due date, November 11, came and went. Kingsley seemed quite comfortable in Kayla’s womb, but he persistently chose to lay with his back to mom’s back, which can make for a longer or more uncomfortable birth. Kayla’s back and hips noticed the days stretching on, and we were all eager to meet Kingsley! Early Wednesday morning November 16, Matt called saying Kayla woke up with strong cramping and back pain. I went to check on her, and it seemed she was in early labor. However, Kingsley was still posterior. We did some exercises and used the rebozo to help turn him anterior, but while morning dawned, her labor slowed. Baby’s heart sounded great, and the water bag was still intact, so we decided to wait and let birth unfold its own way. We midwives left, and Kayla’s labor stopped.

    Four days later, on November 20, 2016, Kayla called saying she thought her waters broke. She was having some minor cramping but no serious contractions, and she could feel Kingsley moving around. I went over to check on her. Kingsley was no longer posterior, and Kayla was really in labor! I called my apprentice Mischa to join us as Kayla’s labor picked up.

    Kayla labored in her big deep jacuzzi bath tub, surrounded by beautiful birth images and affirmations. She surrendered to and embraced her intensifying contractions. Such power the feminine holds in this ability to surrender to the wild power of creation flowing through! Matt was a wonderful support, right by her side as birth swept through her. Kingsley was moving down smoothly and swiftly. Toward the end Kayla felt discouraged, but was reassured when she realized she could already feel Kingsley’s head! Several minutes later, she told Matt to “get in now!” so he could catch the baby. Kayla started pushing, and we could see Kingsley’s head! With a primal birth cry, Kayla pushed out his 15 inch head. Another cry and his body was born into Matt’s welcoming hands. Dad brought Kingsley immediately to mom’s chest.

    Moments after birth, 2 year old Maebe Jane joined the rest of her family in the bath tub for some precious early moments together. Within an hour of his birth, Kingsley and Maebe Jane held hands while they tandem nursed for the first time. What a beautiful birth and sweet growing family!

    

                ~ With blessings and love,
                    Your midwives Micaela and Mischa

Honoring All Mothers

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In the wake of Mother's Day, I want to say Thank You and Bless You to all Mothers.

Thank you for devoting yourself to your children. Thank you for sacrificing sleep and free time for your wee ones. Thank you for showing your children what love is.

Bless your families as they grow. Bless your hearts as they are continually blown wide open. Bless your bodies as you birth and breast feed and carry your children.

Thank You Mothers!

Blossoming Birth is beginning to blossom!

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I just recently embarked on the journey of starting my own business-what a journey! I feel excited about all I am doing with Blossoming Birth and by the energy that is pouring in from all sectors to support this new midwifery practice.

I have an awesome apprentice, Ruthie, who was my housemate at Full Bloom Farm when I first moved to Southern Oregon in 2012. She has since spent one and a half years in Equador studying with traditional midwives there and is excited to integrate what she has learned into the practice. We are really happy to be working together.

And I have my first client! Days after embarking on the journey of starting Blossoming Birth, and without any advertising or seeking on my part, a neighbor texted me out of the blue to see if I could meet with her newly pregnant landmate, to be her midwife.

Overall I am in awe of this unfolding practice, which feels so much larger than me and yet is coming through me and calling me to step up into more of who I am; a loving, passionate, dedicated, intelligent and humble self employed midwife. I am honored, grateful, and so happy to serve. Blossoming Birth is beginning to blossom!