What is a ‘vaginal birth after caesarean’ or VBAC?
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A vaginal birth after caesarean (known as a VBAC) is when a woman who has had a caesarean has a vaginal birth down the track.
In Australia, about 12% of women have a vaginal birth for a subsequent baby after a caesarean. A VBAC is much more common in some other countries, including in several Scandinavian ones, where 45-55% of women have one.
So what’s involved? What are the risks? And who’s most likely to give birth vaginally the next time round?
What happens? What are the risks?
When a woman chooses a VBAC she is cared for much like she would during a planned vaginal birth.
However, an induction of labour is avoided as much as possible, due to the slightly increased risk of the caesarean scar opening up (known as uterine rupture). This is because the medication used in inductions can stimulate strong contractions that put a greater strain on the scar.
In fact, one of the main reasons women may be recommended to have a repeat caesarean over a vaginal birth is due to an increased chance of her caesarean scar rupturing.
This is when layers of the uterus (womb) separate and an emergency caesarean is needed to deliver the baby and repair the uterus.
Uterine rupture is rare. It occurs in about 0.2-0.7% of women with a history of a previous caesarean. A uterine rupture can also happen without a previous caesarean, but this is even rarer.
However, uterine rupture is a medical emergency. A large European study found 13% of babies died after a uterine rupture and 10% of women needed to have their uterus removed.
The risk of uterine rupture increases if women have what’s known as complicated or classical caesarean scars, and for women who have had more than two previous caesareans.
Most care providers recommend you avoid getting pregnant again for around 12 months after a caesarean, to allow full healing of the scar and to reduce the risk of the scar rupturing.
National guidelines recommend women attempt a VBAC in hospital in case emergency care is needed after uterine rupture.
During a VBAC, recommendations are for closer monitoring of the baby’s heart rate and vigilance for abnormal pain that could indicate a rupture is happening.
If labour is not progressing, a caesarean would then usually be advised.
Why avoid multiple caesareans?
There are also risks with repeat caesareans. These include slower recovery, increased risks of the placenta growing abnormally in subsequent pregnancies (placenta accreta), or low in front of the cervix (placenta praevia), and being readmitted to hospital for infection.
Women reported birth trauma and post-traumatic stress more commonly after a caesarean than a vaginal birth, especially if the caesarean was not planned.
Women who had a traumatic caesarean or disrespectful care in their previous birth may choose a VBAC to prevent re-traumatisation and to try to regain control over their birth.
We looked at what happened to women
The most common reason for a caesarean section in Australia is a repeat caesarean. Our new research looked at what this means for VBAC.
We analysed data about 172,000 low-risk women who gave birth for the first time in New South Wales between 2001 and 2016.
We found women who had an initial spontaneous vaginal birth had a 91.3% chance of having subsequent vaginal births. However, if they had a caesarean, their probability of having a VBAC was 4.6% after an elective caesarean and 9% after an emergency one.
We also confirmed what national data and previous studies have shown – there are lower VBAC rates (meaning higher rates of repeat caesareans) in private hospitals compared to public hospitals.
We found the probability of subsequent elective caesarean births was higher in private hospitals (84.9%) compared to public hospitals (76.9%).
Our study did not specifically address why this might be the case. However, we know that in private hospitals women access private obstetric care and experience higher caesarean rates overall.
What increases the chance of success?
When women plan a VBAC there is a 60-80% chance of having a vaginal birth in the next birth.
The success rates are higher for women who are younger, have a lower body mass index, have had a previous vaginal birth, give birth in a home-like environment or with midwife-led care.
For instance, an Australian study found women who accessed continuity of care with a midwife were more likely to have a successful VBAC compared to having no continuity of care and seeing different care providers each time.
An Australian national survey we conducted found having continuity of care with a midwife when planning a VBAC can increase women’s sense of control and confidence, increase their chance to be upright and active in labour and result in a better relationship with their health-care provider.
Why is this important?
With the rise of caesareans globally, including in Australia, it is more important than ever to value vaginal birth and support women to have a VBAC if this is what they choose.
Our research is also a reminder that how a woman gives birth the first time greatly influences how she gives birth after that. For too many women, this can lead to multiple caesareans, not all of them needed.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University; Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University, and Lilian Peters, Adjunct Research Fellow, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Healthy Harissa Falafel Patties
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You can make these as regular falafel balls if you prefer, but patties are quicker and easier to cook, and are great for popping in a pitta.
You will need
For the falafels:
- 1 can chickpeas, drained, keep the chickpea water (aquafaba)
- 1 red onion, roughly chopped
- 2 tbsp chickpea flour (also called gram flour or garbanzo bean flour)
- 1 bunch parsley
- 1 tbsp harissa paste
- Extra virgin olive oil for frying
For the harissa sauce:
- ½ cup crème fraîche or plant-based equivalent (you can use our Plant-Based Healthy Cream Cheese recipe and add the juice of 1 lemon)*
- 1 tbsp harissa paste (or adjust this quantity per your heat preference)
*if doing this, rather than waste the zest of the lemon, you can add the zest to the falafels if you like, but it’s by no means necessary, just an option
For serving:
- Wholegrain pitta or other flatbread (you can use our Healthy Homemade Flatbreads recipe)
- Salad (your preference; we recommend some salad leaves, sliced tomato, sliced cucumber, maybe some sliced onion, that sort of thing)
Method
(we suggest you read everything at least once before doing anything)
1) Blend the chickpeas, 1 oz of the aquafaba, the onion, the parsley, and the harissa paste, until smooth. Then add in the chickpea flour until you get a thick batter. If you overdo it with the chickpea flour, add a little more of the aquafaba to equalize. Refrigerate the mixture for at least 30 minutes.
2) Heat some oil in a skillet, and spoon the falafel mixture into the pan to make the patties, cooking on both sides (you can use a spatula to gently turn them), and set them aside.
3) Mix the harissa sauce ingredients in a small bowl.
4) Assemble; best served warm, but enjoy it however you like!
Enjoy!
Want to learn more?
For those interested in more of what we have going on today:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Capsaicin For Weight Loss And Against Inflammation
- Hero Homemade Hummus ← another great option
Take care!
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Long COVID is real—here’s how patients can get treatment and support
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
What you need to know
- There is still no single, FDA-approved treatment for long COVID, but doctors can help patients manage individual symptoms.
- Long COVID patients may be eligible for government benefits that can ease financial burdens.
- Getting reinfected with COVID-19 can worsen existing long COVID symptoms, but patients can take steps to stay protected.
On March 15—Long COVID Awareness Day—patients shared their stories and demanded more funding for long COVID research. Nearly one in five U.S. adults who contract COVID-19 suffer from long COVID, and up to 5.8 million children have the disease.
Anyone who contracts COVID-19 is at risk of developing long-term illness. Long COVID has been deemed by some a “mass-disabling event,” as its symptoms can significantly disrupt patients’ lives.
Fortunately, there’s hope. New treatment options are in development, and there are resources available that may ease the physical, mental, and financial burdens that long COVID patients face.
Read on to learn more about resources for long COVID patients and how you can support the long COVID patients in your life.
What is long COVID, and who is at risk?
Long COVID is a cluster of symptoms that can occur after a COVID-19 infection and last for weeks, months, or years, potentially affecting almost every organ. Symptoms range from mild to debilitating and may include fatigue, chest pain, brain fog, dizziness, abdominal pain, joint pain, and changes in taste or smell.
Anyone who gets infected with COVID-19 is at risk of developing long COVID, but some groups are at greater risk, including unvaccinated people, women, people over 40, and people who face health inequities.
What types of support are available for long COVID patients?
Currently, there is still no single, FDA-approved treatment for long COVID, but doctors can help patients manage individual symptoms. Some options for long COVID treatment include therapies to improve lung function and retrain your sense of smell, as well as medications for pain and blood pressure regulation. Staying up to date on COVID-19 vaccines may also improve symptoms and reduce inflammation.
Long COVID patients are eligible for disability benefits under the Americans with Disabilities Act. The Pandemic Legal Assistance Network provides pro bono support for long COVID patients applying for these benefits.
Long COVID patients may also be eligible for other forms of government assistance, such as Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Medicaid, and rental and utility assistance programs.
How can friends and family of long COVID patients provide support?
Getting reinfected with COVID-19 can worsen existing long COVID symptoms. Wearing a high-quality, well-fitting mask will reduce your risk of contracting COVID-19 and spreading it to long COVID patients and others. At indoor gatherings, improving ventilation by opening doors and windows, using high-efficiency particulate air (HEPA) filters, and building your own Corsi-Rosenthal box can also reduce the spread of the COVID-19 virus.
Long COVID patients may also benefit from emotional and financial support as they manage symptoms, navigate barriers to treatment, and go through the months-long process of applying for and receiving disability benefits.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Blood-Sugar-Friendly Ice Pops
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
This generic food product has so many regional variant names that it’s difficult to get a universal name, but in N. America they’re also known by the genericized brand name of popsicles. Anyway, they’re usually very bad news for blood sugars, being merely frozen juice even if extra sugar wasn’t added. Today’s recipe, on the other hand, makes for a refreshing and nutrient-dense treat that won’t spike your blood glucose!
You will need
- 1 cup fresh blueberries
- 1 can (12oz/400g) coconut milk
- ½ cup yogurt with minimal additives
- 1 tbsp honey (omit if you prefer less sweetness)
- Juice of ¼ lime (increase if you prefer more sourness)
Method
(we suggest you read everything at least once before doing anything)
1) Blend everything
2) Pour into ice pop molds and freeze overnight
3) Serve at your leisure:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Which Sugars Are Healthier, And Which Are Just The Same?
- 10 Ways To Balance Blood Sugars
- Can Saturated Fats Be Healthy? ← the fats in coconut are a good source of medium-chain triglycerides (MCTs), which are easily broken down as a good energy source and (enjoyed in moderation) thus unlikely to cause any cardiovascular problems, as little to nothing (usually: nothing) of it will be stored.
Take care!
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The Wandering Mind – by Dr. Michael Corballis
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our mind’s tendency to wander can be a disability, but could it also be a superpower? Dr. Corballis makes the case for such.
While many authors focus on, well, how to focus, Dr. Corballis argues in this book that our wandering imagination can be more effective at problem-solving and creative tasks, than a focused, blinkered mind.
The book’s a quick read (184 pages of quite light reading), and yet still quite dense with content. He takes us on a tour of the brain, theory of mind, the Default Mode Network (where a lot of the brain’s general ongoing organization occurs), learning, memory, forgetting, and creativity.
Furthermore, he cites (and explains) studies showing what kinds of “breaks” from mental work allow the wandering mind to do its thing at peak efficiency, and what kinds of breaks are counterproductive. Certainly this has practical applications for all of us!
Bottom line: if you’d like to be less frustrated by your mind’s tendency to wander, this is a fine book to show how to leverage that trait to your benefit.
Click here to check out The Wandering Mind, and set yours onto more useful tracks!
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The Painkilling Power Of Opioids, Without The Harm?
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When it comes to painkilling medications, they can generally be categorized into two kinds:
- non-opioids (e.g. ibuprofen, paracetamol/acetaminophen, aspirin)
- ones that actually work for something more serious than a headache
That’s an oversimplification, but broadly speaking, when there is serious painkilling to be done, that’s when doctors consider it’s time to break out the opioids.
Nor are all opioids created equal—there’s a noteworthy difference between codeine and morphine, for instance—but the problems of opioids are typically the same (tolerance, addiction, and eventual likelihood of overdose when one tries to take enough to make it work after developing a tolerance), and it becomes simply a matter of degree.
See also: I’ve been given opioids after surgery to take at home. What do I need to know?
So, what’s the new development?
A team of researchers have found that the body can effectively produce its own targetted painkilling peptides, similar in function to benzodiazepines (an opioid drug), but—and which is a big difference—confined to the peripheral nervous system (PNS), meaning that it doesn’t enter the brain.
- The peptides killing the pain before it can reach the brain is obviously good because that means the pain is simply not experienced
- The peptides not having any effect on the brain, however, means that the mechanism of addiction of opioids simply does not apply here
- The peptides not having any effect on the brain also means that the CNS can’t be “put to sleep” by these peptides in the same way it can if a high dose of opioids is taken (this is what typically causes death in opioid overdoses; the heart simply beats too slowly to maintain life)
The hope, therefore, is to now create medications that target the spinal ganglia that produce these peptides, to “switch them on” at will.
Obviously, this won’t happen overnight; there will need to be first a lot of research to find a drug that does that (likely this will involve a lot of trial and error and so many mice/rats), and then multiple rounds of testing to ascertain that the drug is safe and effective for humans, before it can then be rolled out commercially.
But, this is still a big breakthrough; there arguably hasn’t been a breakthrough this big in pain research since various opioid-related breakthroughs in the 70s and 80s.
You can see a pop-science article about it here:
And you can see the previous research (from earlier this year) that this is now building from, about the glial cells in the spinal ganglia, here:
Peripheral gating of mechanosensation by glial diazepam binding inhibitor
But wait, there’s more!
Remember what we said about affecting the PNS without affecting the CNS, to kill the pain without killing the brain?
More researchers are already approaching the same idea to deal with the same problem, but from the angle of gene therapy, and have already had some very promising results with mice:
Structure-guided design of a peripherally restricted chemogenetic system
…which you can read about in pop-science terms (with diagrams!) here:
New gene therapy could alleviate chronic pain, researchers find
While you’re waiting…
In the meantime, approaches that are already available include:
- The 7 Approaches To Pain Management
- Managing Chronic Pain (Realistically!)
- Science-Based Alternative Pain Relief ← when painkillers aren’t helping, these things might!
Take care!
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I’ve recovered from a cold but I still have a hoarse voice. What should I do?
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Cold, flu, COVID and RSV have been circulating across Australia this winter. Many of us have caught and recovered from one of these common upper respiratory tract infections.
But for some people their impact is ongoing. Even if your throat isn’t sore anymore, your voice may still be hoarse or croaky.
So what happens to the voice when we get a virus? And what happens after?
Here’s what you should know if your voice is still hoarse for days – or even weeks – after your other symptoms have resolved.
Why does my voice get croaky during a cold?
A healthy voice is normally clear and strong. It’s powered by the lungs, which push air past the vocal cords to make them vibrate. These vibrations are amplified in the throat and mouth, creating the voice we hear.
The vocal cords are two elastic muscles situated in your throat, around the level of your laryngeal prominence, or Adam’s apple. (Although everyone has one, it tends to be more pronounced in males.) The vocal cords are small and delicate – around the size of your fingernail. Any small change in their structure will affect how the voice sounds.
When the vocal cords become inflamed – known as laryngitis – your voice will sound different. Laryngitis is a common part of upper respiratory tract infections, but can also be caused through misuse.
Viruses such as the common cold can inflame the vocal cords. Pepermpron/Shutterstock Catching a virus triggers the body’s defence mechanisms. White blood cells are recruited to kill the virus and heal the tissues in the vocal cords. They become inflamed, but also stiffer. It’s harder for them to vibrate, so the voice comes out hoarse and croaky.
In some instances, you may find it hard to speak in a loud voice or have a reduced pitch range, meaning you can’t go as high or loud as normal. You may even “lose” your voice altogether.
Coughing can also make things worse. It is the body’s way of trying to clear the airways of irritation, including your own mucus dripping onto your throat (post-nasal drip). But coughing slams the vocal cords together with force.
Chronic coughing can lead to persistent inflammation and even thicken the vocal cords. This thickening is the body trying to protect itself, similar to developing a callus when a pair of new shoes rubs.
Thickening on your vocal cords can lead to physical changes in the vocal cords – such as developing a growth or “nodule” – and further deterioration of your voice quality.
Coughing and exertion can cause inflamed vocal cords to thicken and develop nodules. Pepermpron/Shutterstock How can you care for your voice during infection?
People who use their voices a lot professionally – such as teachers, call centre workers and singers – are often desperate to resume their vocal activities. They are more at risk of forcing their voice before it’s ready.
The good news is most viral infections resolve themselves. Your voice is usually restored within five to ten days of recovering from a cold.
Occasionally, your pharmacist or doctor may prescribe cough suppressants to limit additional damage to the vocal cords (among other reasons) or mucolytics, which break down mucus. But the most effective treatments for viral upper respiratory tract infections are hydration and rest.
Drink plenty of water, avoid alcohol and exposure to cigarette smoke. Inhaling steam by making yourself a cup of hot water will also help clear blocked noses and hydrate your vocal cords.
Rest your voice by talking as little as possible. If you do need to talk, don’t whisper – this strains the muscles.
Instead, consider using “confidential voice”. This is a soft voice – not a whisper – that gently vibrates your vocal cords but puts less strain on your voice than normal speech. Think of the voice you use when communicating with someone close by.
During the first five to ten days of your infection, it is important not to push through. Exerting the voice by talking a lot or loudly will only exacerbate the situation. Once you’ve recovered from your cold, you can speak as you would normally.
What should you do if your voice is still hoarse after recovery?
If your voice hasn’t returned to normal after two to three weeks, you should seek medical attention from your doctor, who may refer you to an ear nose and throat specialist.
If you’ve developed a nodule, the specialist would likely refer you to a speech pathologist who will show you how to take care of your voice. Many nodules can be treated with voice therapy and don’t require surgery.
You may have also developed a habit of straining your vocal cords, if you forced yourself to speak or sing while they were inflamed. This can be a reason why some people continue to have a hoarse voice even when they’ve recovered from the cold.
In those cases, a speech pathologist may play a valuable role. They may teach you to exercises that make voicing more efficient. For example, lip trills (blowing raspberries) are a fun and easy way you can learn to relax the voice. This can help break the habit of straining your voice you may have developed during infection.
Yeptain Leung, Postdoctoral Research and Lecturer of Speech Pathology, School of Health Sciences, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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