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Book Review
The VBAC Companion

by Diana Korte
Harvard Common Press
Softcover, 240 pages
Available from LLLI No. 3761, $12.95

Reviewed by Mia Riker-Norrie
Mount Olive, New Jersey, USA
From: NEW BEGINNINGS, Vol. 16, No. 4, July - August 1999 p. 146

The VBAC Companion is a clearly written and thorough guide to lead women step-by-step through the process of planning for a VBAC (vaginal birth after cesarean). Its author, medical journalist and former LLL Leader Diana Korte, has also written Every Womans' Body and A Good Birth, A Safe Birth. In her latest book, she presents many good reasons for encouraging VBACs. The most compelling reason is that they are safer for both mother and baby. Her statements are backed up bymedical facts including fascinating statistics about rates of infant mortality, cesarean birth, and VBAC around the world.

Babies born vaginally are much more likely to be breastfed and enjoy early frequent contact with their mothers. Their APGAR scores are higher, partly because of a surge of catecholamines-hormones which help a newborn baby breathe normally and increase the supply of blood to the heart and brain. Babies born vaginally are also less likely to have respiratory distress syndrome. A mother's risk of infection drops from as high as 35 percent to 2 to 4 percent. Other surgical hazards decrease and women recover more quickly. Women who have had a VBAC often say they feel more bonded more quickly with their babies. Giving birth vaginally can be an emotionally healing experience for a woman who suffered depression after a previous cesarean birth. A VBAC birth is usually less expensive than a cesarean birth. The book includes chapters on how to plan for a VBAC, what it's like to experience a VBAC, and finding VBAC-friendly birth practitioners, hospitals, and birth centers. The personal narratives throughout the book help illustrate different topics. These stories are inspiring and give the book a realistic, personal feel.

Women's biggest fears about VBACs are that the scar from their previous cesarean birth will rupture, that the baby will be too big to be born vaginally, and that doctors and others will think they are being self-indulgent. They also worry about not knowing what will happen in their next labor and if they will be able to stand the pain without medication. It's normal to feel one will fail where other women have succeeded. The author encourages women to appreciate that they did their best with previous births. She suggests getting to know other women who have had VBACs, reading VBAC stories, and practicing visualization and affirmations. All these things can help a woman have a more positive birth experience, including a VBAC in many cases.

The planning section is especially helpful. Korte provides guidelines for seeking a supportive birth environment and caregiver and gives reasons why women might even choose a home birth for a VBAC. The author is supportive of midwives and encourages their use for women wishing a VBAC. Based on the letters Korte has received from mothers who have had VBACs, she suggests that a professional birth assistant (or "doula") provides the most helpful care. (See "The Doula and the Breastfeeding Family," January-February 1998 NEW BEGINNINGS.)

Several of Korte's recommendations are very new such as her suggestions for preventing herpes transmission at birth. She discusses the impact of sexual abuse on pregnancy, labor, and birth-a topic not commonly included in books about birth. Techniques for turning a baby lying in a breech or posterior position are included.

In case a woman ends up having a subsequent cesarean birth, Korte gives excellent suggestions for making it more of a birth and less of a surgical event. In this situation, it is important to choose a doctor with lots of cesarean experience who is prepared to perform surgery only when one has gone into labor. Other important options include regional anesthesia, having your partner or labor assistant with you in the operating room, holding and feeding your baby as soon as possible, and planning on daily help both in the hospital and at home. The chapter "Appreciate Your Birth Experience" pulls everything together and affirms that a woman can work through and learn to live with the outcome of her plans. The author encourages women to work for a birth that promotes both mental and physical health for them and their babies. The book provides extensive bibliographic references and a resource directory which includes sources for labor assistants, childbirth classes, supportive publications, and midwives.

This book fits in well with LLLI philosophy and even uses a variation of a phrase commonly heard at monthly meetings: "Take only what you want from this book, and ignore the rest."

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