The author with her son as she approaches 40 weeks and faces the decision of whether to VBAC or not to VBAC.
That is the question.
Well, for some women it’s not a question—not all hospitals allow women with previous C-sections to attempt a vaginal delivery. Still, the most recent recommendation from the American College of Obstetricians and Gynecologists (ACOG) is that VBAC attempts should be an option for women desiring them, when medically appropriate.
Hospitals that allow women to skip an elective C-section if possible generally require the constant hospital presence of an OB and anesthesiologist during VBAC labors because of the slightly higher risk of uterine rupture. The hospital has to be at the ready if anything goes wrong. For this reason, some smaller hospitals that don’t have enough staff to have someone on site for the entire duration of labor do not allow VBACs. Often doctors will not want to induce patients who’ve had previous C-sections, as the stronger contractions may increase risk of rupture.
But larger, well-staffed hospitals like TMC still allow women to attempt a vaginal delivery. Will the rates of vaginal deliveries after C-sections go up as hospitals provide not only this option, but also support in the form of VBAC prep classes?
The discussion about whether to attempt a trial of labor is one to have early, and perhaps often, with an OB who is experienced with VBACs. Even armed with all the information and a “go-ahead” from one’s doctor, some women do not want to take the chance of going through labor only to end up with a surgical birth.
Amy, a Hebrew school director from Georgia, decided to schedule a repeat C-section for several reasons. “I felt pretty aware when I chose my OB that while he was theoretically okay with VBACs, that he wasn’t exactly going to bend over backwards, she explains. “
“So in a sense, I feel like I chose not to try that hard, if that makes sense. For me, it had a lot to do with my first experience with labor, which was really pretty bad, and desperately not wanting to replicate that experience. I felt like as long as I was doing a VBAC, there was a chance of the same pattern – 2 weeks overdue, induction, long labor, then a C section. I think my top priority in my second birth experience (other than everyone coming out healthy) was not letting it be like my first.”
Shailagh, a psychologist practicing in Oregon, was similarly averse to having a repeat of her first birth experience, and felt that her chances for a successful VBAC were low. “I felt like I could try the uphill path of going for the VBAC, but I had been semi-convinced that what happened with my daughter would happen again: labor did not occur naturally and I was induced because we were past the due date and the amniotic fluid was looking a bit low, then she did not progress when I was induced. She was sort of stuck sideways and did not descend, and I was there for 3 days with the Pitocin [synthetic oxytocin], not eating, and finally had to do the C-section.”
She wasn’t sure that she was willing to have a trial of labor if she felt the outcome wasn’t going to be any different. “I could not face another grueling time capped with a disappointment, so I went for the scheduled c section. The fact that my local hospital (and my OB/GYN) would not be able to do the VBAC made it an easier decision. Had I had a local, supportive caregiver who could give me info and facts that would have led me to believe that I could do labor and vaginal delivery for the second one, I might have done it. It felt like I was sort of on my own with researching and figuring it out.”
As for me? My son was born at TMC in 2006, and I went through the pregnancy certain I would have a vaginal delivery. I even confess to skipping the C-section chapters in the childbirth books. After all, my son was measuring on the smaller end, I had no risk factors, the placenta was ideally located, and I have a roomy pelvis. Why on earth would I have a C-section?
Well, we all know that Things Happen. I was fortunate to already have a (very awesome) epidural in place when it was decided that the only way our boy was going to come out was surgically. I had dilated fully, but because of the position of his head, my cervix swelled, making the opening smaller. (Talk about disheartening—being checked by the L&D nurse and told that you are at 7cm, when you were just at 9cm!!) His heart tracings didn’t respond well to Pitocin-induced contractions, and without the Pitocin the contractions weren’t strong enough to compensate for the swelling. So out he came, not in the manner we expected, but healthy and beautiful with APGAR scores of 9 and 9.
I recovered quite quickly and easily from the C-section, much to my surprise. But when I became pregnant about a year and a half later, I immediately started thinking about my delivery options. My OB practice, formerly Associates in Women’s Health, now Genesis OB/GYN, had a lot of helpful information on VBACs, and they have assisted at many VBACs at TMC.
A repeat C-section seemed like an obvious choice—I already had a (very barely visible, thank you Dr. V!) scar, and this way I would be well rested when the baby was born, and there wouldn’t be any wondering, no potential disappointment. Also, why on earth would I want all that trauma to my vagina when there was a nice neat way to get the baby out? Having a C-section scar AND what I feared would be “a broken vagina” sounded like a raw deal.
…to be continued