Each week I receive phone calls and emails from women inquiring about having a VBAC (Vaginal Birth After Cesarean). With the national Cesarean section rate for birth at an all time high of 32.7% (2009 rates) in the United States, understandably there are many women having subsequent pregnancies and desiring to have a vaginal birth.
I spoke with a woman yesterday who greatly impressed me with her desire for a VBAC. I want to share a few items that stood out in our conversation that will hopefully help others in their quest for vaginal birth. In the interest of privacy, I will refer to her as Mrs. M.
Mrs. M’s first pregnancy was 16 years ago and the labor was full of interventions and ultimately resulted in a Cesarean section, though the baby was in no distress. How does she know this? She requested her medical records. She found out what dilation she was at when interventions were done, what kind of suture was used in sewing her up after the surgery, and other valid information in order to help her make a decision about having a VBAC. She saw on her records what her baby’s heart rate had stayed at and that there was no distress, simply a diagnosis of “Failure to Progress” after only 8 hours of trial of labor.
Following the birth of her first child, she began educating herself about cesarean sections, how to avoid them, and read, according to her, 15 books on having a successful VBAC. Some of the information made her angry and that she had been lied to. Some of the information made her sad that she had not known the information for her first birth. Much of the information inspired her and helped her determination to seek a VBAC.
Upon deciding to get pregnant and have another child, she immediately began exploring her birth provider options. Phone calls were made to hospitals inquiring about their cesarean section rate. One hospital told her that out of over 2,000 births the previous year, only one had been a VBAC. She interviewed up to 10 different providers in her area, including OB/GYN’s and homebirth midwives who attended VBAC. Many of the interviews did not give her the answer for a VBAC, but it did give her an answer about choosing that provider. One OB/GYN told her that she did not and would not attend a VBAC due to the fact the hospital she worked at required the doctor to stay on the floor through the entire labor and birth of a woman attempting a VBAC. The female doctor honestly said, “I am not paid enough to stay on a hospital floor for up to 48 hours.” Another doctor asked her what the “big deal” was about having a repeat c-section and said that she herself had chosen to have an elective surgical birth — and would do it again. Another male doctor asked her how she would feel if her baby died or if he, the doctor, had to break the baby’s shoulder in order to get it out. Rather than being discouraged or giving up on finding a provider, this woman kept searching until she found one she felt comfortable with.
Around 25 weeks into her pregnancy, the provider chosen began setting rules regarding a “trial” for VBAC. The doctor told her she would have to stay in bed, on continuous monitoring, have no food or water, have an IUPC (intraueterine pressure catheter) placed (meaning the bag of waters would be broken artificially), and she would have to dilate 1 cm per hour — or off to surgery Mrs. M would go. A mention of induction at 38 weeks was brought up. This began to bother and worry Mrs.M., so she began searching, again, for a provider for VBAC who would make her more comfortable, even though she was now 25-26 weeks into her pregnancy. She wisely questioned how she could relax and work with her labor watching a clock and wondering if she was dilating 1 cm per hour
Mrs. M contacted another homebirth midwife (not an easy task to find in her area of the country). This midwife recommended a different provider and offered to go with Mrs.M. for the consultation. She met with this new doctor and was reassured she had found the right one and switched practices. Mrs. M. then hired a doula for labor and birth support.
Each time Mrs. M. would be told something negative or have some personal fears or doubts, she would use a fabulous resource she had stumbled across on the internet: ICAN (International Cesarean Awareness Network). She began reading the information on their evidence based papers, as well as joining an online chat and sometimes webinars when they were offered throughout the month. When someone would tell her she had a 13% chance of uterine rupture (not true), she researched the facts and informed herself on the risks and benefits of VBAC. She replaced the negative with positive medical facts, as well as success stories and support.
With her first pregnancy, she did not exercise, watch her nutrition and food intake, or take prepared childbirth classes. In preparing for another pregnancy, she began not only exercising, but teaching aerobic classes up to 11 times a week. She followed a sensible diet and remained active. She enrolled in Bradley childbirth classes and learned about the processes of labor and natural ways to manage them. Sixteen years after the first pregnancy, she is in better shape than when she was a teenager — and far better prepared for the experience of childbirth.
In speaking with Mrs. M, I could sense her determination but also. the struggle it had been for her to find “someone to believe in her ability to have a VBAC”. She called me seeking just a little more support and encouragement, as she is now 36 weeks and some of the things said to her by friends, family, and medical personnel still come up into her mind, along with the fear of another cesarean section. We discussed how very well she has educated herself and covered her bases in preparing for VBAC.
I wish this lady all the success in the world when it comes to having the birth experience she wants and deserves — and feel it will go splendidly for her. In the small chance there is a true medical need for a surgical birth, she may feel disappointment but more importantly she will feel empowered at being involved in the process and decision making. One of the last things she said to me was, “We MUST get this information out to other women and their partners. We must have not only medical facts in order to make decisions but the proper support and encouragement.”
Well said and I shared this for her and for any of you seeking support for a VBAC.
Update: Mrs. M had her VBAC
Update 2014: Most of us have heard of ICAN by this point and we are seeing small changes in primary cesarean rates as well as increases in VBAC. Let’s keep the momentum going!
For more information, please do not hesitate to contact your local ICAN chapter, which can be found at www.ican-online.org
Kimberly Sebeck, CLD, CCCE, Knoxville Doula, All Rights Reserved 2010