Wednesday, May 28, 2008

My Uterus, My Choice


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. 

10 comments:

Kara said...

I'm sorry you do not have very supportive doctors for this. Support is so important for a successful vbac. I had a vbac 2 years ago and am planning another in November, it was the most wonderful thing I've ever experienced. Have you checked out ican-online.org? It's a great resource for c/s and vbac info as well as local support groups. I do want to remind you that even if something is the OBs/hospitals policy they can't force you to do it, such as continuous internal monitoring, mandatory c/s after a certain point, etc. You always have a choice and the right to refuse procedures. Best of luck to you and your little baby.

Melissa Proffitt said...

You know you have my support 100%. If you can convince them to let you do it, and you have no problems, they stop giving you so much crap in the future. I don't think a c-section is in any way the "safe" option here. And my first VBAC baby was 9 lbs. 5.5 oz. That was twelve years ago when doctors weren't nearly so paranoid about it. And somehow I don't think women have gotten more fragile in the intervening time.

Apple said...

Your blog came up in my Google alerts (lucky girl) just wanted to say Good luck on your upcoming VBAC. Definitly check out ican-online.org And to correct you on the current rate of c-sections in the US it's 31% as of 2006 (scary eh!)

Also a couple of things
Bigger babies longer gestations do not stress the scar anymore...heck people VBAC with TWINS! that could be as much as 16 POUNDS of baby in there.

Internal fetal monitoring is NOT necessary or recomended...you will have to have your water broken for that...24hour time limit, and a super highway for infections...straight up the monitor line and into your uterus. Not to mention if baby is in a bit of a funky position you will have a harder time getting him to turn with no cushion of fluid there.

If your Dr. doesn't "perform" many VBACs it's because he's not supportive of them and will likely "risk you out" at some point either prior to or during labor for some reason or another.

Epidurals slow labor, and prevent you from being able to move and turn baby around during labor.

your Dr. is setting you up for failure...ask him how far past due date he will let you go...chances are he won't or he'll grant you 41wks. then will "demand" an automatice c-section.

Your best bet for a succesfull VBAC is with a Midwife, or a TRULY supportive Dr.

See if you have any ICAN chapters in your area (find them at www.ican-online.org)

With hope and peace
A total stranger (and the ican e-list support admin :-D come visit us :-D

B

Spence said...

I support you 100% too. Partially for selfish reasons (Brie's gonna want a VBAC next time around) but mostly because I think it should be your choice. It seems like a good informed consent waiver should prevent any risk of malpractice. I don't see why doctors wont let you make an informed decision. Good luck, and keep fighting the good fight.

Maren, Harrison & Norah said...

You go girl! You have every right to make choices about how your babies enter the world. I'm in your corner!

Jacob said...

Melissa speaks for us both in our support. And we can serve as at least one example of VBAC success. While Teleri was a c/s, the subsequent three were all VBAC without any notable complications. You can safely ignore the rest of this as I bloviate in the usual Proffitt manner. :)

The cynical part of me suggests that c/s is becoming more prevalent because they can be scheduled. Even pitocin isn't as easy to fit into a busy schedule as a scalpel. This is going to be a fight between expectant mothers and their ob/gyns for decades to come.

There's good reasons for this and not all of them are caused by greedy/selfish doctors. The problem is that ob/gyns are in a squeeze. Their malpractice insurance is skyrocketing (rising sometimes 60% and 70% in just a few years and hitting a quarter million in places like Florida and New York) and new-minted doctors are often opting out of entering the field at all as a result (bad hours, cranky women, and watching all your income go to insurance companies tends to add up to a powerful disincentive package). That means that as demand increases and supply fails to keep up (and is indeed declining in some areas—like Florida and New York), ob/gyns are increasingly harried as they attempt to service more patients than they can really handle.

And the risks for the doctors are real. There's a reason that giving birth used to be likened to entering the valley of death. There's a lot that can go wrong and the recently bereaved tend to get a lot of sympathy from juries—which means that the doctor stands a decent chance that at some point in their career they’ll be up in front of a jury trying to explain why they aren’t the bad guy in a tragedy that they simply couldn’t (for one reason or another) prevent. Personally, the case of ob/gyns is a primary reason I support tort reform and caps on damages in lawsuits. There’s a serious “legal tax” on the ob/gyns that doesn’t have to be there. While incompetent doctors should be drawn and quartered, people shouldn’t become millionaires just because they took a risk (even a reasonable one) and rolled snake-eyes.

the coltons said...

you know i support you - either way. i guess i was just super lucky because my c/s was probably an easier recovery for me than a vaginal delivery (everyone's different, but my SIL had a baby a week before me vaginally, her 2nd, and she was having a rough recovery WEEKS after i was back to 100%.) i just count my blessings it was an easy thing for me. next time may not be that way :) you are getting so close and i can't wait to meet little boy proffitt (names yet?) even if it is meeting him electronically :)

sherry said...

I think if you can pull off a vbac you will definately be better off. And you definately seem to be leaning that way. Your Mesa Dr. is one that tends to listen to the views of his patients, and will probably do your vbac if you insist. He is also pretty pliable. If there is something you don't agree with, and you have a good reason, he will probably let you do what you want. That said, he is also a kind of meat and potatoes kind of Obgyn. He is a D.O and not an M.D. He is not very good at surgery (trust me, I have had enough to compare.) which makes me think he may not be great at anything complicated. But he is a fabulous traditional Ob. Also, a couple of points. 1. The reason dr.s don't make you wait until you are dialated to a certain number before you get an epidural anymore is because they have so much evidence nowadays that an epidural does NOT usually slow down the labor process. In fact, you have a few sisters in law who can't really get going until they have the epidural. You also may be a candidate for a lower dose "walking epidural".Or did you just want to try the all natural,excruciatingly painful experience of a drug free labor? 2. breaking your water can really get your natural pitocin going. I have had to do this with each baby, and it has always made me progress much faster. 3. Melissa has a good point about the big babies. You are not likely to have one bigger then she did, and she was fine.4. You are less likely to go overdue with baby #2. I guess my point is this: it really is your decision. Either get your Mesa Dr. behind you, or use your Tucson Dr. The key is to get a Dr. that respects your decision and accepts the fact that you know what you are talking about! Man, I am seriously long winded today!

Anonymous said...

Just a quick comment- I had Internal monitoring just before my emergency c-section. You arent totally confined to bed unless you have an epidural. You can sit in a chair and even stand. sway next to the bed- as long as the cord will reach.

Natural labor isn't that bad. I went over 30 hours natural. it isn't nearly as bad as everyone makes it out to be. And if you have access to a jacussi tub it really helps with the contractions. you should consider giving it a try. Epidurals do have a lot of problems esp. when it comes to VBAC. You would be better off without it when it comes time to push.
Good Luck!!

Anonymous said...

Just a quick comment- I had Internal monitoring just before my emergency c-section. You arent totally confined to bed unless you have an epidural. You can sit in a chair and even stand. sway next to the bed- as long as the cord will reach.

Natural labor isn't that bad. I went over 30 hours natural. it isn't nearly as bad as everyone makes it out to be. And if you have access to a jacussi tub it really helps with the contractions. you should consider giving it a try. Epidurals do have a lot of problems esp. when it comes to VBAC. You would be better off without it when it comes time to push.
Good Luck!!