So I’ve been gone for awhile again – shocker! – but it hasn’t been without good reason, at least to my mind: I had a baby. We’ll call her Miss S. Miss S is 7-weeks-old, and an angel, just like her big sister. But Miss S’s beginning was very different than her sister’s in that she was born naturally, while her sister was a c-section. Which means that yes, I had her by VBAC. And I want to write about it because it’s such a loaded topic, and instills fear in the heart of many women (myself included, pre-Miss S). But the more I talked with people who supported the notion of a VBAC, and the more I read the information in places they directed me toward, I knew that the decision was, for me, the right one, and that it was not crazy. And then just last summer, in the middle of all this talk, the American College of Obstetricians and Gynecologists (ACOG) issued a statement saying that:
Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans…”The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns,” said Richard N. Waldman, MD, president of The College…”Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate.”
Let’s get this out of the way: I’m not some deluded earth-mother out to prove the world wrong. I had a healthy dose of skepticism myself, but at the end of the day I simply wanted the chance to TRY for a VBAC. Just getting my doctor to give me the chance to try was hard enough, let alone to feel that he would be supportive of my laboring like a normal, uncomplicated birth without jumping in for a caesarean for no good reason. Unfortunately, if I wanted a real shot it meant that I had to end my 18-year relationship with my OB-GYN and interview other doctors, which I did. They all had the same stature as him but were what they like to call “VBAC friendly”.
At the end of the day my decision was based on two things: I did not want to have to recover from major surgery again after having my baby, and now there would be a toddler running around the house; but really most importantly was that for me the c-section the first time around was a complete disappointment, like I know that it can be for many first-time mothers. In the end the reason given for going into surgery was that the baby was too large and would not fit. Well, they were right, she was large. Nine pounds, eleven ounces large. So that was not a lie. That she wouldn’t have come out was always a doubtful prognosis from where I stood. But that is not anything for which we will ever have an answer. My husband and I were happy that she was healthy, and at the end of the day that’s all you can ask for. But I also left feeling like something had been taken away from me, and I couldn’t pinpoint exactly what it was. It left me feeling resentful, a feeling that grew stronger as the time passed. But until we got pregnant again and the reality of a possible VBAC came into play, those emotions were vague and yet strong, with no place to put them that would resolve anything. Not except making peace with it, which I was not ready to do.
I heard, like everyone else, and read many accounts online, of women having successful VBAC’s. You read enough and begin to realize that this is happening, and whether your doctor wants to acknowledge it or not, it’s happening with success. But of course you read these accounts and think, “great, that was them. What about me? Could I be the .2% for whom VBAC’s turn out spectacularly badly?” A risk is a risk, after all. It helped that I switched doctors. Just interviewing other well-respected physicians who worked at the same hospital and were colleagues to my previous doctor immediately took away some of the residual fear. For the ones I chose to meet with, a VBAC was definitely an option. For them the reality was that there is a certain amount of risk involved in childbirth period. PERIOD. The task we are undertaking has danger involved no matter which route you go: natural, caesarean or VBAC. But the odds of them thanks to modern technology are very, very slim. And that actually includes VBAC’s. Most women hear the statistic that only 60-70% of VBAC’s are successful and (I’m assuming) they think that number means that a whopping 30-40% of those women end up with a uterine rupture, which of course is extremely dangerous. The truth is that while 60-70% of women who attempt VBAC are successful, the remainder of those women simply end up with a caesarean for the same reasons any other woman attempting natural childbirth does. Once that was cleared up for me, it really became clear that this decision was the right one.
The doctor I chose had delivered many VBAC’s, which immediately put us at ease. I say “us” because I needed my husband on board 150%, and he was. But she also in agreement with us that there would be no induction and was clear that her number one priority was a healthy baby and healthy mother, i.e. the first sign of distress and we were shutting her down. Not being a kamikaze personality, I agreed with enthusiasm on both accounts. If this was meant to happen, the baby would come on her own, and we would labor without a hitch. Both things babies have been doing for millenia.
So, we didn’t go in there hell bent on a VBAC regardless of whatever developments occurred during labor. We were, as they liked to call us, “reasonable” about our expectations. And that also meant that I had to let this birth go on as any birth would, and not labor under a shroud of “VBAC” the entire time. Doing that was not going to change a damn thing, so I had to go in there just doing what any other laboring mother would do. And in the case of modern medicine and epidurals that meant virtually nothing. Miss S did indeed start to come on her own, albeit 6 days late, just four days short of her deadline for surgery. She started her journey on her own and after I received the epidural continued that journey almost entirely on her own. After laying in bed for eleven hours, being monitored non-stop, they told me it was time to push. The knowledge that we – really she – had come to the point of no return was the most surreal moment of my life. And I did get scared right there. For a couple of minutes. Like shaking and vomiting scared. But the deal was closed. Miss S had done everything she could to get us through this journey safely, which meant that she handled every part of labor like a dream, and now it was my turn to step up and finish this thing we had started. After 45 minutes she was out, and my husband and I were not the only ones celebrating in that room. The doctor and all the nurses were so thrilled to have been a part of a successful VBAC, and it was beautiful to see all the support in that room. That was not something I had ever considered, the impact that our trying for a VBAC and being successful would have on the staff working with us. I think they so infrequently see mothers who are given the chance to try that when they do see it they are genuinely excited to be a part of it. But that morning I was laboring there was another woman down the hall trying for a VBAC as well. I think our numbers are getting stronger.
In those moments that followed, something happened that I did not expect: I not only made peace with my earlier caesarean, I was grateful for it. Miss P WAS large, and while I still think that I could have delivered her, I think it would have been at great physical cost to either one or both of us. My previous doctor had been the right doctor for that particular birth. While I had been resentful because I did not feel like I had been given a choice, I knew in my bones right then that we had been right to trust him and his judgement. And similarly I knew that trying for a VBAC this time had also been the right decision. They were simply two different moments. Two different circumstances which required different decisions. And the only reason I could savor that moment as the closing of a circle was because I had been supported in having a choice. And that’s what I want to say to anyone reading this who has ever considered a VBAC: if you want it, it all starts with your believing that you have the right to ask for it.
To read the most current literature on the feasibility of a VBAC, the foremost resources are:
http://www.ican-online.org/vbac/home
http://www.childbirth.org/section/VBACFAQ.html
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