I generally don't like to use my blog as a soap box, but there's an issue dear to my heart (and my growing uterus) that I feel like hashing out- the oh-so-controversial VBAC (or Vaginal Birth After Cesarean). I'm almost embarrassed to bring it up in such a public forum. I still get nervous and sweaty when I talk to my own doctor about having one, like I'm asking permission to poop my baby out in the bathtub by myself in the middle of the night. And that's exactly how it feels... like I need permission to do what most other women do all the time- have a baby the good old fashioned way (not in a bathtub, but vaginally). A little background...
Its estimated that 1 in 4 hospital births will be via c-section (in 2003, 27.6% of women gave birth by cesarean). The reasons for a c-section are vast. I liked this quote, "In the US, a woman is likely to have a cesarean is she's too big or too small; too early or too late; too old or too fearful; too tired of being pregnant or too tired of being in labor; if she's having twins, if she's breech, if she's previously had a cesarean; or if she's due and so is the weekend, Christmas, Thanksgiving, or New Year's Eve. Then again, she's also at risk if her doctor is in doubt, scared of a lawsuit, too busy, going out of town, or convinced that a cesarean is always safer... the reasons go on." (See this article for the source). And on top of it all, c-sections are "cool" nowadays... you've got Victoria Beckham telling us she's "too posh to push." Its out of control.
Don't get me wrong, I thank Heavenly Father on a regular basis for c-sections- without them, either Booker or I would probably be dead. I wasn't about to deliver a breech baby, in fact I've heard the only place that will is called The Farm in Tennessee and it involves something called spiritual midwifery- yeah, totally not for me. My point is that a c-section is MAJOR abdominal surgery and its a procedure that's being performed left and right at the drop of a hat and unfortunately sometimes unnecessarily.
Anyways, what's done is done. I had a c-section and I can't change that. It was in fact, a pretty decent experience. I've never felt such pain in my life, but then again percoset and morphine are kinda fun drugs to try. I had no complications and I recovered in the usual six weeks. But now as I consider my upcoming labor and childbirth, I have a decision to make- a decision that some women aren't even afforded thanks to the growing number of hospitals and doctors that flat out ban VBACs. Repeat c-section or VBAC?
You see, the big hullabaloo about VBACs involves something called Uterine Rupture. Basically, with a prior uterine scar you face a small (about 1 in 500) risk of having your uterus rupture at the site of the scar and having the baby come out into your abdomen (awful, I know). At worst, the baby and/or mom could die. More likely though would be damage to the uterus (resulting in no more children). Doctors and hospitals just don't want to deal with the lawsuits/malpractice insurance and so they refuse to do them. Finding a pro-VBAC doctor these days is nearly impossible. Once a c-section, always a c-section. But VBACs are possible, yet only 13% of women who have had a previous c/s will attempt one. As of now, I'm hoping to fall into that small percentage.
Here are some of the reasons I want to attempt a VBAC:
- I want a big family but I don't want to have multiple major surgeries to do so.
- I want to be able to care for my child right away. Things like changing diapers, nursing and holding my child up will be possible immediately instead of a few days later.
- I want to be able to care for Booker right away. For the first few weeks after your c-section, you can't drive, vacuum, go up and down stairs, pick up heavy objects, etc. There's no way I'm keeping up with Booker with an incision like that.
- A small (very small) part of me has this crazy desire to experience labor. Icky, I know. It must be instinctive.
- Babies born vaginally have higher Apgar scores and are more likely to be breast fed.
Here are some reasons why I'm a good VBAC candidate:
- The reason for my previous c/s is no longer present (well, actually it is at the moment but hopefully this baby will decide to turn sometime in the next 12 weeks).
- I have a horizontal scar and not the vertical one which increases the risk of uterine rupture.
- I am in good health and currently face no complications such as preeclampsia or placenta previa.
Here are some of the small roadblocks I've run into as I "fight" for my VBAC:
- My Mesa doctor does not perform a lot of VBACs, maybe 5 or 6 a year.
- My Mesa doctor has to be at the hospital with me the entire time I'm in labor. Neither of us are too happy about that.
- My Mesa doctor would prefer it if I had a c-section and wants me to have an epidural in place in case they have to wheel me off to the OR. I'm ALL for epidurals, but it kinda feels like admitting defeat before the battle starts. There is also some evidence that epidurals slow labor and increase your c/s odds.
- My Mesa doctor will not allow any type of labor augmentation or induction such as pitocin. That means its all up to me to get this baby out. That's a lot of pressure on me, quite literally. However, he has agreed to stripping my membranes and breaking my water if the conditions are right.
- I will have to have continuous internal fetal monitoring to make sure the baby is doing alright. I'm fine with this, but I do worry a little bit because I'll be confined to a bed which might be annoying.
- My Tucson doctor (although they advertise on their website as being pro-VBAC) has given me an "expiration date." Meaning, she won't let me go past 40 weeks. If this little guy doesn't make an appearance before that, then they'll come in after him with a scalpel. Normally 40 weeks is considered full term, but some women can go as long as 42. Not me apparently. Again, that's a lot of pressure to deliver on time.
- I think I'm the type of woman to have big babies. Booker was early and he weighed 8 lbs 1 oz. My mom had large babies- my brother Danny was 11 lbs. The bigger the baby, the more stress on the scar site and higher risk of rupture.
Overall, I've haven't had a lot of positive support from friends, family and even medical professionals about having a VBAC. Its makes me feel self-indulgent. Why not just take the "safe" route with the known outcome? What if I somehow hurt the baby by attempting a VBAC? But there are risks for both c-sections and for VBACs. The truth is that there's a chance that I'll end up with another c-section anyways. The VBAC success rate is only somewhere around 60 to 80%. But if I don't even try, I'll never know. And the chances of having a VBAC after TWO c-sections are slim to none. So this is my one shot. I'm going in with my eyes wide open and well educated on the matter, happy with either result as long as I have a healthy baby and I don't have to list The Farm, Tennessee as the birth place.