Pregnancy

Whether to try a VBAC

My first baby was breech. He really wasn’t interested in turning, despite my best efforts. I chose not to try a Version based on research about their actual success rates and potential risks, and scheduled a c-section for 39 weeks exactly.

The recovery from a scheduled c-section is much easier than recovering from an emergency section, at least from what I’ve heard. I can see how this would be true, as it’s not like I labored unsuccessfully and then had to add surgery to the mix. I just went right to the operating room, skipping the part where I also wore myself out first.

That being said, I didn’t realize how much of my regular movements were relying on my stomach/core area, and how difficult basic functioning would be. Pooping after a c-section is very painful, but so is walking, standing up from a seated position or standing upright once you’re up, sneezing, coughing, picking up the baby, moving out of bed or getting off of any soft surface like the couch. The first week after my section I remember thinking, “why would anyone choose to do this again?” But a few weeks later, when I was healing nicely and off of the painkillers, I immediately forgot that sentiment.

When I got pregnant with my second baby, the conversations about whether or not to have a repeat c-section (RCS) or try for a vaginal birth started fairly quickly. VBAC, or vaginal birth after cesarean, is a thing. In moms groups and prenatal yoga classes, it’s a big thing. Online, where there are huge Facebook and other internet support groups dedicated to discussing, advocating, and if needed, downright fighting your medical professionals to the bitter end to push a baby out of your vagina, it’s a huge fucking deal.

Prior to my first baby, I thought that once you had a c-seciton you always had to have c-sections. My mother-in-law who had both of her boys via c-section reiterated this misconception, as did anyone in my parents generation. At my annual visit (in that brief year between when I had my first baby and before my second pregnancy) my doctor was doing her thing when she peers around my knees to tell me that I would be an excellent VBAC candidate for number two. I asked her to slow her roll and tell me when I would stop peeing myself when I sneezed.

As my pregnancy progressed, I realized that my primary OB wasn’t just supportive of a trial of labor, she was full on advocating for me to go for it. She was very subtle about it, but I knew that was what she thought the best option would be for me.

Let me say something here about my relationship with my medical team: I was never told what to do or not do; never told what I was allowed to nor was I put in a position of asking permission; and I always felt that I retained my rights as a person to advocate for what I wanted. This is not always the case for pregnant women, which I learned more and more as I began my research of whether or not to try for a VBAC.

Pregnant women still have rights.

Pregnant women and medical professionals can have really bad relationships, with staggering, mind-blowing examples of this found online. I’ve read horror stories of women being given a repeat cesarean section against their will, or threatened with child protective services for refusing interventions. There was a recent case of a woman who filed a criminal case against her doctor for giving her an episiotomy against her will. If you clicked on any of those links and read the stories, you would see why I feel so grateful that that wasn’t my reality with my medical professionals.

It’s not always as dramatic as the blatant physical violations. I have seen the more subtle ways that a power imbalance exists between pregnant women and their providers. It’s sneaky, but it’s noticeable in the language used to talk about childbirth:

  • I’ll see if my doctor let’s me…
  • I want a natural birth, if they let me…
  • I wanted no interventions, but my doctor told me I had to…
  • My doctor said we had to: strip my membranes, induce if I don’t have the baby by 40 weeks, have a c-section for a large baby…

You get the idea.

I’ve been a part of it too. It’s misguided thinking that by having gone to medical school my doctor should make my decisions for me.

Both of my pregnancies were considered high risk. I knew with my first that I would have a more medical birth than some, and way more medical than others. My one sister-in-law had a no-intervention, unmedicated birth – twice, once with a nearly nine pound baby. In my neighborhood, there is a strong group of women that not only support midwifery, but a growing and vocal home birth movement. Seriously, my neighbor had two of her children in the living room.

Since I had to rely on a team of doctors, when the c-section went from a possibility to an inevitability, I expected someone to tell me that’s what had to happen. They didn’t. My primary OB scheduled me for both an ECV with induction and a c-section for the same time. I had to show up and make the decision.

The way my doctor forced me to make my own decisions instilled a very deep trust in her as a practitioner. I’ve since recommended her to my friends and neighbors, and even my mother now drives nearly two hours to see her as well.

When it came down to whether or not to try for a vaginal birth, I stressed myself out ahead of time. I did a ton of research on the risks of a VBAC versus success rates. I asked my doctors for statistics on success rates of an induced VBAC. I posted in moms groups to ask people their non-medical opinion. I joined one of the VBAC support groups on Facebook which I found filled with a lot of hardline, anti-medical professional rhetoric, which based on my experience I found disheartening, but understandable in the face of so many nightmarish experiences for others.

I measured about a week or so ahead from 24 to 32 weeks. At one point my MFM told me he thought I would have a nine pounder. In my monthly fetal growth scans I watched as my second boy consistently measured anywhere from the 65-85th percentiles, until the last official scan at 36 weeks when he was estimated to be what I thought was a more realistic size. I had one last unofficial scan at 38 weeks when I begged the tech administering my BPP to take a look. His guess was 6lbs, 10 ounces, which turned out to be exactly what he weighed when he was born a week later.

 

32 weeks pregnant and in my bestie’s wedding. That bride looked extra skinny next to me.

When I felt confident that I wasn’t going to have a huge baby I was more willing to consider a VBAC. Statistically, the scariest complication of a VBAC is uterine rupture, which can occur in roughly 1:100 women. There are other potential complications too, and then of course there’s always the possibility of having an unsuccessful trial of labor (TOLAC) and ending up with an emergency section.

I told my doctor that my biggest priorities were:

  1. My safety. I didn’t want to die in childbirth in 2015.
  2. The safety of the baby.
  3. The easiest recovery possible, as I still had another baby at home (yes, 21 months is a toddler, but trust me, it’s also very much still a baby).

Knowing that, she told me that my options from the best possible outcome to the least-best outcome would be:

  1. A successful VBAC
  2. A scheduled section
  3. A failed VBAC ending in an emergency section

And then she told me I had to make my own decision.

One of the doctors on the team was willing to give me his recommendation. Dr. B suggested that I schedule both a c-section and an induction for 39 weeks and let my cervix be the deciding factor. If my cervix wasn’t dilated at all at 38 weeks, I could mentally prepare myself for a c-section and then check again at 39 to see if I had started to dilate.

The dilation issue was important. In order to be induced for a TOLAC, the only options are a foley bulb and Pitocin. All of the other medications, like the cervical ripening agents are off the table. And you can’t induce with either the bulb or the drugs if you are at zero.

We discussed methods of helping the process along. Dr. B told me that the only thing that has any medical merit is sex. Considering how huge and not like having sex I felt at 37 weeks when we had this conversation, I pressed for the merits. It’s similar to stripping the membranes, and much less painful. He also said that I could try chiropractic, massage or acupuncture, all my non-sex alternative ideas, but the evidence on those was lacking at best to nonexistent at worst.

I did my best. I ate spicy food, walked, had a prenatal massage and saw an acupuncturist.

Dr. B checked me at 38 weeks and I was one centimeter. I was going for a VBAC.

 

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2 thoughts on “Whether to try a VBAC

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