October 29, 2013

VBAC: Interview With A Mother Facing A Decision

With a national average of 30% of US births being done via cesarean section, the decision to try a VBAC (Vaginal Birth After Cesarean) is something many women will face. I recently sat down with Sasha, the mother of 2 year old Charlotte, who is due in December with her second child. She openly discussed her thought process that has led her to the decision to attempt a VBAC with her second child.

What are some of the reasons you want to do a VBAC?

In a way the main reason is to have the experience of a vaginal birth. I was really disappointed not have that experience the first time. I never considered the possibility of having a c-section. I was pretty upset and disappointed, though I was grateful above all to have a healthy baby. I also believe a vaginal birth is beneficial to the baby and the mother, in terms of the hormones at birth and recovery from a vaginal birth. There are lots of good reasons not to have major surgery. Although it was not as bad as it could have been. But, again, a lot of my desire for a VBAC has to do with wanting the experience; to know I did it myself.

What are some of the reasons you were considering not going for a VBAC?

I don’t want to repeat the experience I had last time. While I dilated quickly, I pushed for 2 hours. She was really low, the doctor could even feel her head. But they didn’t want to pull her out [instrumental birth, foreceps or vacuum extraction] because of the presentation of the head being asynclitic. In trying for a VBAC, I run the risk of putting my body through hours of labor and then ending up w a c-section again. The risks, however low they are, aren’t something that I feel good about. But I am not overly worried about them either. In all the scenarios, trying a VBAc and ending up with a c-section, or having a scheduled c-section- the risks are fairly low. Again, I come back to my fear of repeating the last experience, which is something I really don’t want to do. I was physically so battered, that by the end of delivering Charlotte, I was exhausted. Part of that was because I so shocked and disappointed about the c-section. But if it goes that way this time, I will know how to deal with it better. That is the benefit of experience! Attempting a VBAC, I know there is a chance I will end up with a cesarean, so it will not catch me by surprise as much. Also, I know what the recovery will be like. Fortunately, nursing was was not a problem with Charlotte. The positive side was, I didn’t encounter the negative side effect of what can come with a c-section. That said, the first 24 hours afterwards were NOT GOOD! Having all those drugs in my system was really unpleasant. And I was so bloated with fluids. I gained 10 pounds AFTER the birth because of all the swelling! That day was really hard because I really wanted to enjoy what I was going through and embrace motherhood. Instead I was throwing up, bloated and itchy.

I also was introduced to a study done out of NYI (NYU?) that my doctor cited about the correlation of dilation and the possible success of a VBAC. The study suggested that women who dilated 6-9 cm have the best chance of a VBAC- 70%. But the women who dilated to 10cm had a 13% chance of a successful VBAC. That study was very discouraging to hear. Thirteen per cent sounds miserable. I am a little disinclined to take this study as gospel. And even though I have seen this one particular study, I also know of other studies that say the opposite. Truth is, we just don’t know how everything will turn out.

Do you find your care provider supportive of your decision? If so- how? If not- how?
Yes- I think my doctors are totally supportive. They are not pushing me in one direction or another. They offer me a lot of different perspectives; talk to me about the pros and cons about each option. Although the hospital does requires I sign a form about the decision to have a VBAC. It states that I know what I am doing and I understand the risks of a VBAC.

My doctors and I came to a compromise that I would schedule the cesarean a few days after my due date. Other doctors usually plan the c-section before or on the due date. My OB feels pretty strongly that if I am going to try a VBAC it is best to have the labor start on it’s own before the due date. She explained the risks go up after passing the due date. But ultimately, they are compliant with waiting a few days after my due date. Part of this could also be because my due date is over the weekend. Of course, I can always change my mind if we get to that point and I am not comfortable with my choice. I am convinced I will go into labor before hand. Waiting until full term and few days past, gives me a chance to try and let my body do what it might be able to do on it’s own – which I hope it will! If I get to a point where my body is not looking like it wants to do anything then I can make the call.

The doctors have been very supporting of my compromise about scheduling the c-section after my due date. They have said to me- they will look at me and see what my body is doing and how the baby is doing instead of just making a firm decision ahead of time about their procedures their procedures. The only negative is – they are still traditional doctors and they don’t have certain knowledge about different ways to try a birth. For example- introducing nontraditional positions to push in. I was on my back for the two hours while I tried to push Charlotte out. Ultimately doctors may say, “I think you should throw in the towel now” … because they have exhausted all they know when there could be other options. Nobody said, “This doesn’t seem to be working, pushing on your back, so let’s try on your side” or had other suggestions. I wish I had a little more time the first time and the knowledge to try other birthing positions. Everyone’s knowledge base comes with assets and limitations. This is why I am strongly considering having a doula present this time for the birth.

Where have you received your information about VBACs from?
Aside from my doctors- I have done a lot of online research. You obviously have to check the source. There are some better ones and more questionable ones. But there is a lot relatively good information online.

Do you feel support or pressure from friends or family to go either way? VBAC or planned cesarean?
My family has been very supportive about my decision for a VBAC. The whole time, I feel like the decision has been in my hands- even though my partner is involved, he trusted my instincts to try a VBAC. Everyone has been respectful that ultimately the choice is in my hands. It is a blessing and a curse!

Knowing there is a decision made- I feel more at peace. I am going to give my body a chance to do what it can. And knowing there is plenty of space for my body to start labor on it’s own feels reassuring. However, it is also nice to also have a limit. Right now it feels OK to have a cut off date. There was a long time when I was ready to go ahead and schedule the c-section. There is definitely comfort in knowing when it is going to happen, especially with a toddler at home. I could go in at 8am and have a baby by noon. But ultimately, scheduling it after my due date gave me a sense of something I could predict but also space for things to go on their own. This is a good compromise for me.

I truly believe following your instincts is important. It is such an individual decision and we all have our own priorities. Your experience from your first birth will ultimately shape your decision for the next.

My hope from this article is, that it may help other women who are facing this same decision. Understanding the fears, concerns and desires of another mother may help open the path to a deeper examination of the option for a VBAC.




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