The birds of Houston have mistaken our third floor balcony for a bird sanctuary. The former residents of our home did nothing to discourage this, but we have paraded several experts through our bedroom to study the small balcony and offer suggestions. Our efforts to decrease the bird population (and resulting huge mess) came to a halt last spring when a nest with an egg appeared on the floor of the balcony. Even though we had been actively trying to get rid of the birds, we enjoyed peaking through the blinds on the door to check the progress of the egg. Finally it hatched and we watched the tiny bird grow. I actually fretted if I thought Mama was spending too much time away from her baby. One day when I checked, the nest was empty. The Mama had successfully launched her newborn. Over the rest of the year, we managed to decrease the number of birds making our tiny balcony their home perch, but the floor of the balcony was still available. This spring, a new nest, this time with two eggs, appeared in exactly the same spot as last year. Once again, several times a day I would peak through the blinds to check the progress of the two eggs. Finally, two tiny birds appeared. Every time I checked after that, Mama was firmly perched on her nest. Then yesterday, Mama was gone, and I could see one very still baby bird in the nest. I knew it was dead, but nonetheless I checked several more times in case the baby bird had been “sleeping.” But no, the baby bird was really dead. And that is a harsh truth – babies of all species sometimes die.

There is nothing that a pregnant woman fears more than losing her baby. Thus, there has been a major set-back for TOLAC/VBAC (trial of labor after cesarean/vaginal birth after cesarean) with the publication of two recent studies in PLos Medicine. Henci Goer has done an excellent job of analyzing both studies and explaining why the conclusion heralded in press  – that VBAC is always more dangerous than elective repeat cesarean – is wrong. In 2010, the National Institutes of Health convened an expert panel who studied the risks and benefits of TOLAC/VBAC. One of their important conclusions was that evidence indicates that the risk of uterine rupture during TOLAC/VBAC is statistically about the same as the risk of a major complication happening to a nulliparous (first birth) woman. The difficult truth is that there is some risk during every pregnancy; a woman who has had a previous cesarean has increased risks for both herself and her baby whether she chooses TOLAC/VBAC or repeat cesarean surgery. The more cesareans that she has, the higher the risks. As a society and as childbirth educators, we need to do a better job of acknowledging that sometimes, despite everyone’s best efforts, complications and even deaths occur. We need to spend some time in every series on unexpected outcomes and grieving. We have chosen a field that mostly has happy endings. But we have to recognize that all tragedies cannot be prevented and present our students with a realistic picture of pregnancy, labor and birth and of the risks associated with each.