Why a Vaginal Birth After Cesarean should be a Viable Option
This is not a story about which experience is "better." It is a story about choice.
My second birth as a student doula was with a woman who was hoping to have a vaginal birth after cesarean. She had spent a great deal of time preparing. Bradley Method classes, a doula, and an obstetrician that was willing to “let her try” to give birth vaginally. 40 weeks came and went-and her doctor started talking about an induction. Wanting to keep things as low-risk as possible my client tried all sorts of natural induction methods, however at around 41 weeks she found herself in triage awaiting induction. They had talked of pitocin but her cervix was not favorable. I remember it so clearly-induction points, clary sage oil, me at her feet, sister at her right hand and partner at her left. We were going to force her cervix by sheer will into submission.
Hours had gone by and almost 40 births later I have yet to see the pitocin dosage reach higher levels. I was so new to it all but I remember thinking they sure were giving a lot of pitocin to a woman attempting a VBAC. It made no sense, if the main fear was uterine rupture why were they pressing that button so often? This woman was in a great deal of pain-the contractions were intense and she tried so hard. Semi-sitting in bed (continuous fetal monitoring), rocking back and forth with our heads together –25 plus hours later her cervix remained at about 8 1/2 -9 cm and she had a repeat cesarean. Her bladder was nicked in surgery and she ended up with a blood transfusion as well.
Flash forward-a few months and a few births later. Second pregnancy-first was a cesarean in London-this time she was going vaginal. Her husband was out of town so the birth team consisted of myself and my doula mentor. Labor started on my way home from another birth. My doula mentor came and picked me up after only a few hours sleep. We arrived at our client’s house and we labored. We stayed at home for as long as possible and left for the hospital in the morning. When we arrived she was in active labor and they skipped the normal admittance procedures and assigned us to our room where we labored some more. It was amazing-the energy, the vibe, the movement, the flow-they left us three women in the room to our own devices where we just let mom and her baby do their thing. Not only was I in the presence of my first VBAC-I was experiencing my very first natural birth. I am still in awe.
Having a VBAC is a bit different than having “just “ a vaginal birth. There are some things you should know-for instance, why was a cesarean performed the frist time and what can you do differently. And at the same time there are similarities in terms of how you can prepare -eat healthy, exercise, get a doula, work with and understand your feelings about giving birth-find a way to explore your fears-trust the process and gather a team that can help create a healthy, positive energy around you and your birth.
Repeat cesareans should never be routine - major abdominal surgery takes a great deal of time to recover from and it is not without risk. In addition it is unethical for hospitals or doctors to institute bans against VBACS either formally or informally and goes against the concept of informed consent. Although cesareans can be and are medically necessary at times-the old adage “once a cesarean always a cesarean” no longer applies – a woman has a choice and she should not be bullied in either direction-the choice is hers. I had planned to go into the history of Cesareans and VBACS but that information is easily accessed-this is about the experience itself-the importance of a woman wanting to do things her way-the way that feels natural to her. Asking why would anyone want to attempt a vaginal birth after a surgical birth is the same as asking why a natural birth instead of a medicated birth or why a homebirth instead of a hospital birth. It’s all about choice, personal preference.
All a woman need do is a little research-the evidence is out there-why is the option of a VBAC a vital option? According to Ina May Gaskin in Spiritual Midwifery she “continues to recommend VBAC to most women who have had a previous cesarean” because looking at the risks of elective repeat cesarean, we have the following:
More respiratory distress in babies from iatrogenic prematurity and wet lung syndrome
Accidental laceration of the baby (two to six percent of cesareans in some studies)
Higher infection and injury for mothers
Higher risk if maternal death (two to four times that of vaginal birth)
More complications in future pregnancies, including placenta previa (seven times the risk after just one cesarean), Placental abruption (three times the risk), various degrees of placenta accrete (25 times the risk) and ectopic pregnancy.
In addition research has shown:
Babies born vaginally are usually born when they are ready, rather than prematurely by surgery
Babies born through the birth canal have the benefit of a surge of catecholamines, which are essential for survival
Babies born through the birth canal are more likely to be born with healthy lungs
Babies born vaginally have higher Apgar scores
Babies born through the birth canal enjoy early, frequent contact with their moms
Babies born vaginally are much more likely to be breastfed and to be nursed for a longer period of time
The fact is as evidenced in the first birth story-not everyone who attempts a VBAC will get a VBAC. Some women who do everything “right” will end up with a repeat cesarean and some women like in the second birth story will have a different experience. The key word in the entire discussion surrounding repeat cesareans and VBACs is options. Current research has shown that over 86% of women who have had a previous cesarean can have a subsequent vaginal birth. It is our job as consumers, advocates, mothers, and women to make sure no one is standing in her way.
Some excellent resources:
The VBAC Companion: The Expectant Mother’s Guide to Vaginal Birth After Cesarean
By, Diana Korte