The Trouble With Wanting a VBAC
With first babies, you have all the choices in the world how to give birth — drug-free, with a doula, in a hospital surrounded by the family, c-section. Not that the plan always works out, but a mom-to-be can dream.
With subsequent babies, however, the options narrow quickly for a group of women who, for whatever reason, wound up giving birth to the first via cesarean section.
Pamela Paul’s article in this week’s Time, “The Trouble With Repeat Cesareans,” would more accurately be titled “Hey, Good Luck With That VBAC.”
Paul doesn’t set out to argue whether women should be allowed to choose to give birth via c-section. Rather, she illustrates how, for an alarmingly large number of women, the choice to give birth vaginally isn’t even there — c-section is the only apparent option.
She writes that although VBAC is a safe option, nine out of 10 women with a prior cesarean undergo repeat cesareans for subsequent births. Of course repeat cesarean might be the woman’s choice, but vast numbers of are basically forced into the operating room.
From Time:
…the International Cesarean Awareness Network
(ICAN), a grass-roots group, recently called 2,850 hospitals that have
labor and delivery wards and found that 28% of them don’t allow VBACs,
up from 10% in its previous survey, in 2004. ICAN’s latest findings
note that another 21% of hospitals have what it calls “de facto bans,”
i.e., the hospitals have no official policies against VBAC, but no
obstetricians will perform them.
These bans left one California woman to drive 100 miles to a hospital where she would be allowed to attempt a VBAC.
This is interesting because the National Institutes for Health, recognizing the tremendous cost and associated risks of surgical birth, has set a goal of decreasing the number of cesareans by, in part, upping the VBAC rate to 37 percent by 2010. In 2006, VBACs only accounted for 8 percent of all births in the U.S.
Paul counters the studies and VBAC safety fears many women, doctors and — probably most importantly — insurance companies operate under. And explains how we got to where we are today, even though just over 10 years ago, attempting VBAC was quite common. Several high profile lawsuits sent malpractice insurance through the roof. She qoutes a doctor who admits the “once a cesarean, always a cesarean” is an issue of money, not patient safety.
Paul also writes on Huffington Post her own experience when she wanted a VBAC. She found who she thought was a VBAC friendly doctor, only when she was six months pregnant he wanted to talk c-section scheduling. She balked and when she went in to give birth, the on-call doc at her supposedly VBAC-friendly hospital wouldn’t talk to her while she was in labor and didn’t answer his pager when it was time for her to push. Lovely!
I’m curious whether what hoops you had to jump through to get support for a VBAC or if you had to through in the towel. If you had a repeat c-section, was that your choice? Avoiding the battle?
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Photo: Time
ChiLaura — Some women may have narrow pelvis problems, but unless they are very very very small, that is probably not the reason the labor was long. And, not all midwifes are created equal. Labor can take days, and that is within the realm of normal. We dont have the patience anymore to allow labor to progress at its own pace. Get the Ina May Gaskin book, and read about experienced midwifes, and her birth stories. Super interesting stuff.
I had an emergency c-section after a 36 hour labour with my first child.
After I read about the potential complications of a VBAC and spoke with doctors, friends and family, I opted for a scheduled c-section for our second child. The recovery from the scheduled c-section was very short and the whole experience was excellent.
As I understood it, if my labour progressed well and everything went normally, the risks of complications with a VBAC were lower than the risks with a planned c-section. But, and this was the big BUT, if there were complications in the VBAC, the risk of VBAC was much higher than the risk of planned c-section.
I’m cautious by nature and had a really difficult first delivery so I opted for what I considered to be the safer route; the scheduled c-section.
I had a VBAC with my second child thanks to the caring and encouragement of my midwives. I had to have a “chat” with the OB at the hospital when I was in labour to make sure I understood the risks, but overall Women’s Hospital in Vancouver is very supportive of VBAC and I felt supported in my decision. Pushing out my son was one of the proudest and happiest moments of my life.
I had a c-section for my one and only pregnancy. I was in labor for about 3 hours first, and the contractions were very painful. I thought the experience of having a c-section was kind of gruesome, and the recovery was difficult (while caring for newborn twins). Still, I really don’t feel cheated. In my particular situation, both my doctor and I felt the section was the way to go. If I ever get pregnant again (which I doubt), I would probably try to have a vaginal birth if it was reasonable to do so. I wouldn’t want to have another c-section if one could be avoided.
Kacey, I so relate to your story! Because of my first c-section, I got a staph infection and had to stay in the hospital 8 days, then went home with a catheter in my arm to give myself liquid antibiotics for the next two weeks. It was a terrible experience. My second c-section went much better, but even so, recovery is painful and long.
It’s nice to see your positive attitude about it, and you’re right: we did make these perfect children, and that should be enough. I’m not quite over it yet, but I hope to get where you are soon.
Cheri, what about laura’s story, right above yours? I have a friend who apparently has a narrow pelvis, too (2 kids, 2 C-secs, both times labored with midwives). Is that a lie by the medical community? I’m curious about your perspective.
I had a vaginal birth, then a c-section, then a VBAC. If you want a VBAC yu have to be really pushy. My doc was great about it though.
I had a C section with my first at 40 weeks 2 days. We scheduled it after trying 2 doses of the cervical gel with absolutely no change in dialation or effacement. I had pregnancy induced hypertension and had been on Blood pressure medicine since 16 weeks and had gestationsal Diabetes. They didn’t want me to go too far past my due date and said they could induce, but wouldn’t recommend it due to the fact the gel treatments didn’t work.
So C Section it was. The recovery was awful and I ended up in the ER 10 days after giving birth with severe abdominal pain. Turned out to be nothing, but man did I hurt.
Second Baby… I asked my doctor if I went into labor on my own, if they would let me attempt a VBAC. They didn’t have any problem with it. I went ahead and scheduled the Section anyway. As time got closer, there was no progress and I wasn’t about to do those Gel treatments again. So I went with the C Section. Much better the 2nd time around. I knew what to expect and not to push myself.
That being said. I don’t feel cheated at all by the fact I have never felt a labor pain. I still created the two most awesome kids and I don’t care how they got here, I am just glad they are here and healthy.
Everyone who has a C-section has to tell themselves they made the right decision. I get that. As long as everyone came out OK, healthy baby, living mama….I guess it WAS the right decision. BUT….this does not mean it was the only decision that could have been made. Csection rates are super high, unnecessarily. “failure to progress” “small pelvis” “cord wrapped around the baby’s neck” “fetal distress” “just not made to give birth” are all things we hear over and over to justify Csections the first time….and the second. I did the research. Read all of the relevant medical research papers…and in spite of what your Dr might tell you…Csections are rarely medically justified. “better safe than sorry?” I guess so. But, I wish people could just admit that fear…Mother’s fear, Dr’s Fear, Hospitals Fear…Fear is the reason for so many csections, and subsequent repeat csections.
And, Yep, I had what was essentially a VBAC. Even was induced. 3 days of hard hospital labor, a big baby and everything came out great in the end. It was long, it kinda sucked, I was scared, but I had a supportive Doctor and Husband. I was both lucky to have them, and very very insistent that I would not have a csection. If you really do not want a csection, get the books, do your research, and find a Dr. who you trust, and who trusts you.
Research has shown that a csection rate of around %8 is a reasonable and conservative number. The other %20 of deliveries that are csections are unnecessary, dangerous, and based on lies and fear.
I had 2 sections.
With the first I ended up in counseling after. I thought I was ok with either method of delivery, turns out that I wasn’t. I went into labor on my own with both children.
Because of that I was hoping for a VBAC, convinced that I ended up with the first section because we went in to early, they broke my water, got the epidural too early, needed pitocin, etc.
My OB practice was supportive of the VBAC, but encouraged me to schedule the 2nd section anyway. They felt the first was due to a narrow pelvis. I thought that was BS. Fortunately, the hospital has strict rules on repeat c-section ( and induction) scheduling. Because of the recent studies about how much better it is for the baby to be delivered as late as possible, the hospital does not allow repeat sections to be scheduled before 39 weeks. Inductions have to be 2 weeks overdue for the first baby and 1 week overdue if it’s your 2nd. Medical necessity will trump these rules ( risk to mother, breech, etc).
I scheduled my 2nd c/s for 39 weeks 5 days. I ended up going into labor at 38 weeks 6 days. I labored at home, wishing for drugs, in hopes that delaying the trip to the hospital would help my chances of VBAC ( we live 3 minutes from the hospital, otherwise I would not feel comfortable staying at home as long as I did).
By the time we went in, I was sure that I was VBAC bound.
Turns out, I have a narrow pelvis.
After 12 hours of laboring at home, 2 hours at the hospital, a check revealed that I had made no progress from my appointment 2 days prior.
Neither of my children ever entered the birth canal. So in my case, the docs were supportive of the choice, but for me it was a necessity.
Another example of malpractice lawsuits taking away many of our choices.
I live in Italy where in most hospitals ‘once a C-section always a C-section’ is generally the rule. I was extremely disappointed when I had to have a C-section with my first child, and with my second child was fortunate to find a local hospital that supported my decision to try a VBAC. The hospital informed me of the risks of VBAC vs. a repeat C-section and required me to sign a waiver indicating that this information had been presented to me. My story ended with a positive birth experience and a quick recovery.
I opted for my repeat c-section. My doctors and hospital were actually all quite supportive of the VBAC option, and I’m certain I could have gone that route with them if I had wanted to. However, after 36 hours of labor with my first, and then having a c-section, I opted to skip the whole labor portion the second time around, and it was most definitely the right choice for me! However, I think that every woman should have the option of a VBAC, and if that’s what the pregnant lady wants, that’s what the pregnant lady should get!
My doctor was supportive of me trying for a VBAC after my first cesarean. I ended up choosing a repeat c-section because even though I had the “go ahead” there were a lot of restrictions that would have been put on my labor since I had already had a previous cesarean. Would I have been allowed to try to birth vaginally? Yes. But once you have already had a c-section it’s not like you are going in with a “clean slate” so to speak. Doctors are much more cautious to monitor every aspect of your labor and quicker to suggest another cesarean at the first sign of anything not going well. I also choose another cesarean for problems that occurred in my first birth that were at risk of happening again. There was another hospital within 45 minutes of us that didn’t even allow VBAC at all because they didn’t have 24 anesthesia available. I am having my third cesarean in two days (and very excited). Had I wanted to attempt a VBA2C I would have had to drive to a hospital over three hours away to even be considered. I guess my point is that I think women encounter all different scenarios. And going for a VBAC isn’t an easy decision for many. But especially if you have to fight for it every step of the way. I was ultimately happy with my cesareans and they were the right decision for me. I think it’s important for women to know there can be good cesarean experiences when they are necessary. I do however, wish that women who would like to try VBAC didn’t have such an uphill battle in many cases.
My wife really felt cheated by having a c-section with our first child, so she really wanted to have a VBAC with out second. We used a midwifery with both deliveries, they were always present in the hospital, and the midwives were very, very supportive of her wishes.
Since we knew we only wanted two children, my wife and I made a deal: If she had to have another c-section, while she was on the operating table, she’d get a tubal ligation. On the other hand, if she managed a VBAC, I’d go under the knife.
Well, despite some nasty back labor, my son was delivered vaginally.
Snip-snip.
I wanted to try VBAC so bad with my second-born! My docs let me go 10 days past my due date before they “made” me have a c-section. I use quotes because they were actually very nice about the whole thing. They were hesitant to induce me after a VBAC (I actually thought most docs won’t induce for VBAC at all, but then my sister was induced for her VBAC and delivered her second-born with no problems). Because my baby was big (born at 9 pounds, 10 ounces), they thought an induction would be dangerous, so they recommended a c-section when it appeared he wasn’t budging at 10 days past my due date. So now I’m a mom with two wonderful children, but I’ve NEVER gone into labor and never felt a labor pain. Some of you will groan at this, but I’m envious of those of you who have had vaginal births. I feel a bit cheated (or like I cheated) by having never gone into labor. My first-born was also late and not budging, and she was 11 pounds, 1 ounce at birth, so they wouldn’t induce since she was so big (of course, they only had estimates until she came out). Oh, well, I’m just happy that my darlings are healthy!
I doubt we’ll have a third child, but if we do, I don’t think they’ll allow VBAC after two c-sections, will they?