This is not a comprehensive list.
Obstetrical emergencies like:
-prolapsed cord (where the cord comes down before the baby)
-placental abruption (where the placenta separates before the birth)
-placenta previa (where the placenta partially or completely covers the cervix)
-placenta accreta (where the placenta is too deeply embedded in the uterine wall and has potential for maternal hemorrhage)
-eclampsia/pre-eclampsia (pregnancy-induced high blood pressure, causes severe swelling due to water retention, and can impair kidney and liver function. If it progresses to eclampsia, toxemia is potentially fatal for mother and child.)
Other common reasons we hear for cesarean are:
-fetal malpresentation such as transverse lie or breech (many are not given a full range of options such as vaginal breech birth with a skilled provider or external cephalic version to turn a malpositioned baby)
-suspected cephalopelvic disproportion aka CPD – (meaning that the head is too large to fit through the pelvis. Actual condition is very rare. This is often over diagnosed, and many women do go on to have vaginal births after a cesarean for CPD)
-Maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc.)
-fetal distress. (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.)
If you have not already had an epidural or spinal anesthesia for labor, or this is a scheduled cesarean, you will most likely be given a regional anesthetic (epidural or spinal). If there is a reason that you can’t get regional anesthesia or it is an emergency you may be given a general anesthetic. You also may be offered a pre-operative sedative, and the surgical consent form may say this is a possibility. In family centered cesareans, sedatives are typically not offered, as it can make it more difficult to be alert and present during your birth. After the birth, you may have the option of IV or oral pain medications, which you should discuss with your provider.
“VBAC” is an acronym for vaginal birth after cesarean. Other variations of this acronym may be used to describe more specific birth situations, such as HBAC (home birth after cesarean), or VBA2C (vaginal birth after two cesareans).
As the meaning behind the acronym implies, a VBAC is a vaginal birth after a prior cesarean. Many people that labor after cesarean will go on to have their babies vaginally (VBAC).
When discussing a VBAC, uterine rupture is a specific risk that is typically mentioned. Uterine rupture occurs with a separation of the uterine wall. Uterine rupture can be life-threatening and serious, however, the risk of uterine rupture occurring is very rare, affecting less than 1% of those laboring after cesarean with a low transverse incision. Studies show the risk of uterine rupture decreases with each VBAC.
Every pregnancy is different and it is important to evaluate your situation carefully with a trusted healthcare provider. Although there are some specific definitions set in place by organizations such as ACOG defining who is and isn’t considered a “good candidate” for a trial of labor after cesarean, they also recommend evaluating individual circumstances with your healthcare provider.
Many hospitals have bans on laboring after one cesarean, or laboring after multiple cesareans. These bans can make it harder to have a VBAC, however, it does not mean that a repeat cesarean is required. Every patient has the right to informed decision making, which includes the right to accept or decline procedures or medications. You may find the hospital complaint system to be a good starting point in determining birth options.
Many women have delivered their babies vaginally, even with more than one prior cesarean. A vaginal birth after multiple cesareans, for many woman, may be a low risk option. It is important that a woman is well-educated and informed before making the choice to VBAC after multiple cesareans. You should discuss this risks, benefits, and alternatives with your healthcare practitioner.
Induction is not contraindicated in most labors after cesarean, however, the majority of studies show significant risks associated with the use of prostaglandin cervical ripeners in TOLAC. Chemical induction in general has been shown to increase the risk of uterine rupture. When the benefits of induction outweigh the personal risk factors, some may feel comfortable creating an induction plan with their provider.
Some of these may go in a different order, and a few left out, but these are the basics:
- A catheter inserted to collect urine
- An intravenous line inserted
- An antacid for your stomach acids
- Monitoring leads (heart monitor, blood pressure)
- Anesthesia
- Anti-bacterial wash of the abdomen, and partial shaving of the pubic hair
- Skin Incision (vertical or midline(most common))
- Uterine Incision
- Breaking the Bag of Waters
- Disengage the baby from the pelvis
- Birth (Accomplished by hand, forceps, or vacuum extractor)
- Cord Clamping and cutting
- Newborn Evaluation
- Placenta removed and the uterus repaired
- Skin Sutured (Usually the top layers will be stapled and removed within 2 weeks.)
- You will be moved to the Recovery Room (If the baby is able s/he can go with you.)
Every surgeon has a different procedure for c-sections, including the type of incision and closure. You should discuss this with your doctor to determine their typical plan. It is generally 5 minutes from the time that they make the initial incision until the baby is born. The rest of the surgery may take between 30 and 40 minutes, including repair, depending on circumstances of the birth.
Most hospitals will allow you to go into the operating room with your partner, or if you feel unable to, they may be accompanied by another person (some hospitals will allow two if one is the doula). Hospitals utilize Family Centered Cesareans, which means involved the family as much as possible. They will encourage you to participate in the birth, both cesarean and vaginal birth. For hospitals that do not support Family Centered Cesareans, you should meet with them to discuss the level of involvement you will be supported in.
Basically, an emergency cesarean would be any cesarean that wasn’t scheduled ahead of time. Some may involve a medical emergency, and some may not.
A planned cesarean is simply one that is scheduled ahead of time.
A repeat cesarean is a scheduled cesarean after having had a previous cesarean.
CBAC stands for “Cesarean Birth After Cesarean”. This is usually used to refer to an unplanned cesarean after a precious cesarean.
Everyone’s recovery will be different, depending on your age, body type, and general health. However, some basics of recovery will be to remember that you have just had major abdominal surgery, as well as given birth to a new baby. You may experience gas pains, incision pain, uterine contractions (your uterus will still need to work to get back to its original size). If you have staples or steri-strips, they may be removed about 4-7 days postpartum, but every provider has a different post-op plan, so you should discuss this with them. Try to rest. Get as much help as you can with your daily activities. If you have any questions, or concerns, reach out to your provider immediately. There are no “stupid questions”. It is important to discuss your concerns with your provider so they know how to help you.
By the end of six weeks, some people say they are feeling better, although the timeline is different for everyone.
After a surgery, you may need extra support while breastfeeding. Do not hesitate to ask for help. Your hospital should have a lactation consultant on hand to help you get started. In Family Centered Cesareans, those wishing to breastfeed are encouraged to begin breastfeeding in the operating room.
The International Cesarean Awareness Network is a non-profit organization whose mission is to improve maternal-child health by reducing preventable cesareans through education, supporting cesarean recovery, and advocating for vaginal birth after cesarean (VBAC).
There are currently over 100 ICAN chapters throughout the world. Volunteer chapter leaders do most of the work in supporting families in their communities through in-person meetings, email, social media, local events, and fundraising. In addition, ICAN utilizes online support and educational webinars.
Visit our “Find A Chapter” tab to search for a chapter near you. If you cannot find a chapter close to where you live, we have a general ICAN group that may be helpful: https://www.facebook.com/groups/ICANOnline/. You may also be interested in starting a chapter. This information can be found at “Starting a Chapter”.
The burgundy color of the ribbons represents birth and the wearing of the ribbon upside down symbolizes the state of distress many pregnant women find themselves in when their birthing options are limited. The loop of the inverted ribbon represents a pregnant belly and the tails are the arms of a woman outstretched in a cry for help. The shape also signifies the uterus and fallopian tubes. The Cesarean Awareness Ribbon debuted in April of 2004 for Cesarean Awareness Month.
If you feel so upset that you fear that you might harm yourself or your baby, please seek professional help immediately by calling 911 or contacting your doctor.
ICAN believes that everyone needs support after birth, especially if they consider their birth experience to be traumatic. Your feelings are valid. ICAN chapters facilitate peer-to-peer support through building a community of maternity care consumers in local environments. Different ways that ICAN can support can be found under the “Support” tab.
Local chapter leaders provide support through online, and in-person meetings. Find a local chapter using the “Find A Chapter” tab.
ICAN was founded in 1982 in the United States as the Cesarean Prevention Movement, in response to a birth climate that enforced a “once a cesarean, always a cesarean” rule. In the 21st century, the rate of cesarean births in the United States has skyrocketed to 33%. While ICAN believes that cesareans do save lives when used appropriately, we recognize that the increase in the number of cesareans has not resulted in an increase in healthy mothers and babies. ICAN has worked tirelessly to encourage evidence-based birth practices, and educating mothers about their choices in birth.
ICAN is an all-volunteer organization. The ICAN board of directors consists of a President, Vice President, Secretary, Treasurer, and other Board Members as needed. In addition, Regional Coordinators help support local chapters, which are led by official chapter leaders. An Executive Team leads various volunteer projects for ICAN. Contact information for the current leadership team is available on the Contact page.
Membership in ICAN is available at several different levels, beginning at a 1-year supporting membership of $30. Members receive benefits based on the level of membership, and all items are subject to change. Throughout the year, ICAN provides free or discounted access to educational webinars featuring birth professionals from many fields. While most of ICAN’s services do not require membership, we urge anyone who believes in ICAN’s mission to become a member in order to support our work. Visit (Join page) to join ICAN today.
ICAN divides the money collected from memberships between the local chapter and the national organization, when a local chapter is named as beneficiary. Local chapters keep 30% of the membership funds to use for meetings, events, activities, or education as needed. The remaining 70% is used by the national organization to pay for the website and software, tax assistance, insurance, postage, and all things that keep organizations of this size running. ICAN operates with a very small budget, and the Board of Directors works hard to use those funds wisely. ICAN is 100% volunteer led and operated, including the Board of Directors.
ICAN does not recommend care providers. Many local chapters will collect names of providers who support VBACs and Family Centered Cesareans, but ICAN realizes that choosing a care provider is a personal choice and no one provider is right for every person. Each person should determine on their own what they will need in labor, and find a care provider whose values and personality line up with their needs. Start the process of finding a care provider by talking with peers about their experiences, and then consider scheduling consults to discuss your birth plan. Some states will also make cesarean and VBAC statistics available by hospital. You can also check to see if your hospital currently has a ban on VBAC. You might want to call the hospital yourself to determine their current policies, as guidelines may change without notice. Remember that you can change care providers at any time in your pregnancy.
Visit our Advocacy page to read about options when your hospital does not support laboring after cesarean. Some options include meeting with the hospital to discuss any concerns you have with current policy.
ICAN’s Professional Membership Directory includes doulas, childbirth educators, chiropractors, massage therapists, hypnobirth instructors, midwives, obstetricians, lawyers and anyone else who feels they have a service they can provide to people during their childbearing years. Professional Members have paid a fee to be listed in our directory and agreed to support our mission; however, this is not a guarantee that they will be the right professional for your needs. ICAN’s Professional Membership Directory is intended as an informational resource for consumers. Please understand that ICAN is not a credentialing agency or a regulatory body. As such, we are not responsible for the competency of the professionals listed. Consumers are encouraged to take responsibility for their birth journey by informing themselves regarding the competency of those professionals that they retain. Arranging interviews, asking open-ended questions, and obtaining local reviews (Local ICAN Chapters are a great resource!) can be a great place to start in vetting the service providers you hire.
Are you a Professional interested in being listed? Learn More.
Because ICAN is run by volunteers, we always need help fulfilling our mission. If you would like to contribute your time and talents to our mission, please contact our volunteer coordinator at volunteer@ican-online.org or visit our “Volunteer Positions” page. Opportunities are available at all different levels of involvement.
- VBAC – Vaginal Birth After Cesarean
- TOLAC – Trial of Labor After Cesarean
- CBAC – Cesarean Birth After Cesarean. Usually used to describe a birth in which a woman wanted or planned a VBAC, but the birth ended in a cesarean.
- VBA2C (or VBAMC) – Vaginal Birth After 2 Cesareans (or Vaginal Birth After Multiple Cesareans)
- UBAC – Unassisted Birth After Cesarean. A vaginal birth in which no birth attendants were present, usually only the mother, and perhaps her partner or family members.
- ECV – External Cephalic Version. This procedure is used to try to turn a breech baby to a vertex position during the 3rd trimester. The care provider will place his/her hands on the outside of the pregnant mother’s abdomen and will press on the abdomen in order to manually force the baby to turn.
- ERCS – Elective Repeat Cesarean Section. A cesarean usually scheduled and performed without labor, when the mother is not planning a VBAC.
- OP – Occiput Posterior. A position in which the unborn baby is facing toward the mother’s front, which may make delivery more difficult.
- LOA – Left Occiput Anterior. Considered the best position for the unborn baby during labor.
- CPD – Cephalopelvic Disproportion. A questionable medical diagnosis in which the baby’s head is supposedly too large to fit through the mother’s pelvis. This is one of the most commonly used reasons for performing a cesarean.
- FTP – Failure to Progress. This is a questionable diagnosis that declares the woman’s labor to be too long, or stalled. This is another commonly used reason for performing a cesarean.
- PROM – Premature Rupture of Membranes. This is when a woman’s “water” breaks before labor begins.
- SROM – Spontaneous Rupture of Membranes. This is when a woman’s “water” breaks on its own during labor, in contrast to having a care provider break the membranes manually.
- NST – Non-Stress Test. This non-invasive test, performed in a doctor’s office or hospital, is an indicator of how well a baby is doing inside the womb. This primarily involves monitoring a baby’s heart rate over the course of about 30 minutes or more. An NST may be recommended by your care provider if you have any complications or risk factors that may impact your baby’s health. It is common for care providers to also recommend an NST when a pregnancy extends beyond a woman’s due date.
- BPP – Biophysical Profile. BPP is a prenatal ultrasound evaluation of fetal well-being involving a scoring system, with the score being termed Manning’s score.[2] It is often done when a non-stress test (NST) is non reactive, or for other obstetrical indications.The “modified biophysical profile” consists of the NST and amniotic fluid index only.
- ACOG – The American College of Obstetricians and Gynecologists. This is the professional organization that publishes guidelines for doctors to guide their practice.
Chapter Leaders must be current ICAN Members – Supporting Level or higher – and maintain membership for the duration of their leadership role.
You will need to fill out the ICAN Chapter Leadership Application. Completing this application does not guarantee opening a new chapter or becoming a part of Chapter Leadership. The Chapter Director or the Regional Coordinator for your area will contact you via email for an interview. If you are not contacted within two weeks concerning your application, contact the Chapter Director or the Regional Coordinator for your area via the “Contact Us” Page. It is very important that you check your email and spam folder for communication.
- U.S. based Chapter Leader (Chapters can have as many chapter leaders as needed): $60
- U.S. based Secretary/Treasurer (Reduced training, and cannot host meetings alone): $30
- This fee is non-refundable
- Applicants outside of the United States should visit this page.
Once your leadership fee is paid, members of Chapter Leadership must sign and return the Chapter Leadership Agreement which includes:
- The Chapter Guidelines
- ICAN’s Statement of Beliefs
- Chapter Leadership’s Code of Ethics
- Conflict of Interest Policy
- Non-Disclosure/Confidentiality Agreement
- Leader Training Commitment
Your interviewer (Regional Coordinator or Chapter Director) will provide you with a link to fill out this paperwork upon completion of your interview and asssessment.
Once the Chapter Leadership Agreement is signed, you are a Chapter Leadership Candidate! You will be assigned a temporary ICAN email and invited into Chapter Leadership Training. This training consists of seven modules designed to equip you to lead a robust chapter in your community.
The seven modules are:
- Get to Know ICAN
- Running a Chapter
- Holding Meetings
- Education
- Support
- Advocacy
- Financial Matters
Chapter Leaders are required to do all seven modules. Chapter Secretaries are required to do the first two modules. Chapter Treasurers are required to do the first and the last module. You have three months to complete the training (with an option to extend to six months, should circumstances require), though many finish within a few weeks. The modules are a go-at-your-own-pace format, so you can do as little or much each day as your time allows.
You’re an ICAN Accredited Chapter Leader! New chapters will be formally assigned a name, given an official opening date, an ICAN chapter email, ICAN phone number and a Facebook page and group (to be created by the Board of Directors). Chapter Leaders will be given access to the ICAN Leadership Center – a place for resources and links for submitting additional paperwork, etc. Additional resources can be requested as needed, such as a chapter website. Thank you for joining us!
All ICAN Chapters must:
- Hold meetings at least 6 times a year.
- Complete a Chapter Quarterly Report (CQR). This takes a few minutes and can be submitted with ease online.
- Attend a virtual continuing education meeting each quarter for one hour.
- Complete a financial report once every 6 months to send to the ICAN Treasurer. This typically takes around 15 minutes to complete, but often takes less time for new or small chapters with little or no transactions.
- Complete a yearly inventory of any chapter items (books, brochures, etc.)
- Respond to inquiries your chapter receives by phone, email, or social media in a timely manner.
Some chapters choose to go beyond these basic requirements and have monthly meetings, hold chapter fundraisers, have informational booths at local events, etc., but these things aren’t required. We understand that each area has its own unique needs, and we respect our volunteers’ availability.
Accredited Chapter Leaders receive support from their Regional Coordinator, US or International Coordinator and the Chapter Director, along with the Board of Directors. Leaders must complete the training to become an ICAN Accredited Chapter Leader as part of opening or joining a chapter. This ensures that each Chapter Leader starts out with a strong foundation. They also have access to the ICAN Leadership Center where new training, resources and tools are being added continually. As volunteer availability allows, occasionally there are also Chapter Leader teleconferences and Webinars. There is a private Facebook group for Chapter Leaders throughout the world where you can crowd-source ideas, ask questions about concerns or other issues, and build friendships!
Chapters can have as many Chapter Leaders as needed. It is great to get others involved with your chapter! They will follow the same process as outlined above. If they are not already a current ICAN member, and your chapter has funds, you can use chapter funds to pay for the chapter leader fee and membership fee of the applicant.
Some chapters have other Accredited Chapter Officers such as Treasurer and Secretary. While many chapters do thrive with only one Chapter Leader, many chapters find it beneficial to enlist the help of other volunteers as Chapter Officers. Chapter Officers must be current ICAN members and follow the same process above as well. There is no limit on number of Accredited Chapter Leaders or Officers.
Yes! Please visit our International page for more information. Chapters outside of the United States do not have membership or leadership fees. An application and interview will be required.
Fill out the application above and either the Chapter Directer or your Regional Coordinator will contact you to discuss the application. You may find that the application process will answer many of your questions. At that time we can personally discuss your concerns and answer any additional questions. Do not pay the Chapter Leader Fee until your application has been approved. If you would rather discuss a quick question over email you can contact your Regional Coordinator or the Chapter Director with any other questions you have.
