#vba3c

*Below is a Guest Blog Post I did for the magical, Jetta of Family First Midwifery*

If you’ve never heard of the term VBAC, it stands for “Vaginal Birth after Cesarean”, and it’s supported by ACOG as the safe and reasonable choice for women after one or two cesareans.  I teach VBAC classes, and frequently consult with professionals and expecting parents about the evidence for VBAC.  Before I was a doula, I led a non-profit organization that promoted VBAC birth and advocated against unnecessary cesarean births. But before all that?  I was just a Mom that wanted something different out of her birth experiences after having two cesareans; one which was very needed, and one which was wholly unnecessary.

Would you believe there was a time where I would encourage friends and family to have a cesarean?  I’d announce, “C-sections are easy!  You just lay down, they take your baby out and that’s it!”  That woman is certainly light years away from where I am today, but I remember every step of the journey I took to get here, and I definitely don’t judge that woman.  I did what worked for me and my family, and when I knew better, I did better.

I remember asking my provider with my second pregnancy what my birth would look like since I’d had a previous cesarean. Forever I’ll remember that his “informed consent” discussion with me was this statement: “Cesareans are more dangerous for you.  Vaginal birth is more dangerous for the baby.  Most mothers pick what’s best for their baby.”  Naturally, I picked cesarean.  Besides, once a c-section, always a c-section…right? (Spoiler alert: wrong)

My second pregnancy was super healthy, and my baby was growing perfectly – just bigger than average.  They moved my due date up by 2 weeks, and then they scheduled my cesarean a day or two before my 39th week.  I never questioned anything.  I felt lucky that I got to meet my son even sooner and fully trusted my providers.  My son was born with the development of a 36 week old.  He struggled breathing when he was born, was nearly air evac’ed to a local children’s hospital.  He spent over a week in the NICU.  They wouldn’t let me breastfeed, I couldn’t hold him, and for the first time I wondered how my doctors could have gotten this so wrong.  Specifically I remember the obvious thought, “Maybe doctors don’t always know everything?”.

There are two things I’d like to interject here: 1) I was raised by doctors and nurses and I support and believe in the medical system.  Doctors generally want what’s best for us, and I believe that.  2) The OB system in America is not well, and for a myriad of reasons.  We know this because we don’t stack up against other industrialized and modern countries when it comes to maternal and fetal safety during birth and postpartum. Our cesarean rates are high, and our mothers and babies are dying at higher rates than 46 other countries.  I don’t believe there is anything wrong or different with American women; I think there is something wrong with our birth culture.  There is unmistakable evidence for the safety of things like VBAC, delayed cord clamping, and homebirth – and unmistakable evidence of the uselessness of things like routine cervical checks, routine continuous fetal monitoring, and arbitrary rules about not eating during labor.  And yet, we get stuck in this cycle of doing things as they’ve always been done, just because we’ve always done them that way.

I also want to be very clear, that I am not anti-cesarean.  The World Health Organization recommends an average cesarean rate of around 10% to keep mortality rates for women and babies at its lowest.  That means 10% of the time, cesareans are needed to keep us safe and I am so grateful for that intervention when it’s needed.  The problem is that our cesarean rate in America hovers around 30%; meaning 1 in 3 women will have a cesarean.  And of those women, many are walking away from their birth with false understandings about their bodies their ability to birth.  Did you know only 20% of women will attempt at TOLAC (trial of labor after cesarean) after their first cesarean, and only 7% of women will attempt TOLAC after two cesareans?  Yet less than 50% of the women opting for a repeat cesarean truly understood the risks and benefits associated with their choice for birth.  For me the crisis isn’t just about unnecessary surgical intervention, but that women are not given the respect of informed consent.  

When I was asked to write this guest blog post for Family First Midwifery, and the amazing Jetta, I sat down to write about the facts of VBAC: why it’s safe, why it’s totally reasonable and how it’s usually totally achievable.  All of that is true, but I feel like it’s missing the crucial first step: deciding a VBAC is the right choice for you.  That’s the first step of just about anything right?  And so my first official piece of advice is this: make the decision to try for a VBAC or whether cesarean is a better choice for your family.  You’ll need the certainty of that decision as you go through this journey.  I’ll go first: My name is Jenni, and I wanted to push a baby out of my vagina. 

It really doesn’t matter why you want to push a baby out of your vagina.  Maybe you hated your cesarean experience, maybe you’re afraid of hospitals, or maybe you just want to see if your body can do it.  All that really matters is that you find the courage and the motivation to go for it because girl, you’re gonna need it.

VBAC can feel like an up-hill battle.  After taking that first step and deciding to go for it, the next step of figuring out “what’s next” can feel incredibly overwhelming.  The journey starts with finding a provider that is truly supportive of VBAC, a hospital that will allow you to birth with evidence based care, and then helping your family understand that it’s not like you’re choosing to birth unassisted in a forest under the moon – you just want to push a baby out of your vagina.  It’s not fair, but it feels like we’re making this radical birth decision – there can be SO much judgment.

More than anything, that’s what I remember about planning my first VBAC; all the well-meaning conversations that made me feel like I was putting myself and practically everyone in the delivery room in danger by choosing VBAC. 

“So when is your c-section scheduled?” my friends and family would ask. 

I would prepare myself and answer, “Oh, I’m actually planning on a VBAC.” 

Then, “What’s a VEE-BACK?” 

That was always followed with an explanation, then a horrified gasp at my maverick birth choices, followed by my prepared VBAC101 elevator speech that covered the high-level facts and safety of VBAC.  I realized quickly who was in my peace bubble, and who was going to shake my confidence in my birth journey.  I sorted them accordingly and abstained from further birth conversations with the latter.  So this is my second piece of advice: find supportive (informed) friends to share your birth planning with.  We are not obligated to explain our birth choices to anyone, and it’s much easier if you can surround yourself with supportive and encouraging people.

Other helpful contributions from friends and family (and the internet) you’ll get when planning a VBAC: “What about your other children?”, “You don’t get a medal, you know.”, “Isn’t it just easier to do a cesarean?”, “You know, your mother/sister/grandma could never push a baby out.”, “Don’t people die from VBAC?”, “I heard your uterus could rupture!”  Unfortunately, we need to be rock solid on our evidence, or it can be really scary and we’ll be easily rattled by outdated or flat wrong information.

If you’ve heard about VBAC, you’ve probably heard the term, “uterine rupture”.  A uterine rupture can be dangerous, but is not common.  Even though a scarred uterus is more likely to rupture, it is still not statistically likely to happen.  There is an average of 0.4% rate of uterine rupture in women that started labor autonomously (without the help of induction or augmentation).    Making a decision to have a cesarean because of the risk of uterine rupture is akin to checking yourself into the hospital for a cold, because it may become pneumonia. You are more likely to experience the negative effects of the infection and risk in the hospital setting (or cesarean) than you are just proceeding as normal (with a vaginal birth).  It’s important to understand uterine rupture; how the risks are increased, what interventions are contraindicated and what the signs and symptoms are.  Understanding the whole picture helps take the big and scary out of uterine rupture, so you can realistically prepare.  That said, my third piece of advice is this: I encourage you not to let fear control your decision making.  We all have to do what we feel is best, but I can assure you that uterine rupture is not the biggest risk you can face when having a baby; it’s simply exploited because it’s statistically and specifically more likely to occur in cesarean women.  I want to emphasize: Being “more likely” does not equal “likely”.

I could literally go on and on, and on and on and on.  There are so many myths, fear-tactics and misunderstandings when it comes to VBAC, and birth in general.  My hope is that any readers of this post would feel more empowered, and open to exploring their options for birth.  A medicated hospital birth is the norm, and even cesareans are considered “normal”, but there are resources and birth professionals that can help you navigate this journey so that you can walk away from whatever birth experience you have feeling empowered and respected.