Monday, 11 June 2012

• VBAC - Controlled Risk or Unnecessary Danger?

  
  When I was 10 days "overdue" with my first child, I agreed to my Ob's suggestion that we should induce. When I was induced, they started me on pitocin and simultaneously broke my water (which didn't hurt). I got "stuck" at 9cm for a couple of hours and during that time, I finally agreed to the epidural because I couldn't take it. I couldn't take that advanced labor (and my daughter was also facing forward which is more intense) for such a prolonged period of time, and was too exhausted to concentrate on relaxation methods any longer. After the epidural, they upped the pitocin again. And two things happened. 

  I dilated to 10.

   

  Baby's heartrate became erratic.

   

  My doctor emphasized that we had to push her out now now now. Well, as I said, my daughter was facing the wrong way, and it just wasn't happening fast enough - so I was horrified to hear that I had to have a cesarean.
  
  

   

  I cried the entire way to the OR. I shook from powerful hormones, exhaustion, and emotions during the entire surgery. I was annoyed when the anesthesiologist kept asking if I was cold because I was shivering so badly. I wasn't cold, I was having a traumatic experience. The only part I can look back at and smile on was that my poor husband was finally prepped and walked into the operating room when they were in the middle of the cesarean and they had my organs out of my body. And at the end of it, as my OB was stitching me up she told me that I would not have to do this again. That she was stitching me up in a way that make a natural vaginal delivery an option for the next baby. That my incision was ideal for that. She reiterated that when she visited me later during my hospital stay and again when I saw her for my postpartum visits.

   

  Fast forward 2 and a half years. I became pregnant again.

   

  I went to the same group of doctors who had delivered my daughter. I saw them for a few months before the subject of VBAC or scheduled cesarean came up. At that time, I asked them about their opinion on VBAC safety. They were unfavorable. I asked why. One of the drs said, "No one sues you for performing a cesarean, they sue you for not doing one fast enough." Another said she would support a trial of VBAC *if* I didn't gain more than 30 lbs during my pregnancy because "truly emergent cesareans are more difficult and potentially more complicated the larger your patient is."

   

  I finally asked, "If we decided to try for a VBAC, what would that look like? What would your protocols or guidelines be before you gave up and took me to the operating room?" I was told that I would have to go into spontaneous labor prior to my due date. That if labor did start on it's own, once contractions were 10 minutes apart, I must go to the hospital. And from that point on, I must dilate 1 cm per hour or I would be operated on.

   

  I would like to know who would succeed with that as a guideline? They were setting me up for a cesarean but fooling me into thinking I had a choice of a VBAC.

   

  _______

   

  The truth is, the American Congress of Obstetricians and Gynecologists (ACOG - the nation's experts, the leading authority on Ob/Gyn practices) recommend the right to a trial of labor after cesarean within a certain set of standards. 1. The incision should be the low transverse kind (most incisions these days are this type). 2. There cannot be a preexisting medical condition which would make a vaginal delivery unsafe. More about their recommendations can be found here: http://www.acog.org/~/media/For%20Patients/faq070.pdf?dmc=1&ts=20120601T1250249554

   

  _______

   

  So now I had a medical practice I no longer trusted had my best interest in mind, particularly since they weren't honest and upfront with me from the beginning. And I was 6 months pregnant. Time to find a new dr.

   

  Little did I know how difficult this task would prove. I lived in a very large city, with many medical choices, and at least 6 hospitals. As soon as I said the magic word "VBAC" I was shut out.

   

  I eventually went to a local midwife group, and took their tour and the opportunity to speak with them. They asked me to stay after the tour (with other moms-to-be) and talk with them privately. I did. And when I told them why I was there, that I could find no doctor who would give me the right to choose in the absence of medical complication and within the guidelines ACOG laid out, they wept with me. They could not legally attend my child's birth in the state in which we lived. I was probably going to have to have surgery against my will for no medical reason other than the fear or the unknown. 

   

  I considered that surgical assault. I would not consent without medical reason. I would not have a repeated cesarean for the sake of a protocol written by the legal department.

   

  For a few weeks the midwife group helped me figure out my options, and eventually, they found a doctor who had attended and (most importantly) supported VBACs. In order to see her, I had to stop working full time, and go to a part time status in order to get out of my insurance coverage (and onto my husband's) in the middle of the year. There was only 1 hospital in the city who did not have an outright ban on VBAC! And that is where we delivered. When we toured the hospital (yeah I was ready to pop when we toured, but everything about this pregnancy was about action and reaction, plan and re-plan), I asked the head nurse how many VBACs they had. None. They also did not look favorably upon them. I was also told I would not be able to bring my iPod or a birthing ball, nor would I be allowed to use the shower when in labor, etc. I felt very pessimistic about how this experience would go.

   

  Other than my new doctor who was VERY supportive and thrilled to attend, the midwives who helped me find my dr, and my immediate family - I felt like the whole world was against me. Against what I was trying. And there were many times I had to ask myself why I wanted to have a vaginal birth after cesarean.

   

  Here were my reasons:

  1. I did not want the number of children I can have artificially determined by how many "zippers" I could safely have.

  2. Cesareans themselves carry risks both to the mom and to the baby.

  3. The healing process after a cesarean is typically much, much longer than that of a vaginal birth (and this was a concern because we were being transferred across the country in the military 1 month after my baby was due).

  4. I knew that this was my only chance to turn it around. Once you have two cesareans, you'll be even harder pressed to find support for a trial of labor rather than a scheduled cesarean. I'm not even sure I would try that one, although I know many who have successfully had uncomplicated vaginal births even after having had 3 c-sections.

   

  And finally, because I felt it was a controlled risk. I would be laboring in the hospital, just like every other Mom. As if I had never had a child before. If things became complicated, I had staff and a physician who were trained and capable of taking the means necessary to preserve life, mine and my baby's. I knew that trying for a VBAC was not a guarantee that I would have success at it. I knew I could still end up with another cesarean, but at least I would know that I gave it all I had - that I had tried.

   

  So long as I went into labor. That was my new doctor's guideline. At 41 weeks she would become uncomfortable and begin stress tests etc, and I could not go even a day past 42 weeks. We were in agreement. She also requested that I have a non-medicated birth, no epidural (which was ok with me because that was also my plan). Her reason was this : IF something were to go wrong (the concern is of course uterine rupture) the first symptom of that is unusual pain, followed by bleeding. If you were deadened or dulled to that pain by medications then the rupture could become advanced before you were aware of it. 

   

  We were going to attempt a VBAC. A controlled risk in a controlled environment. With an unknown outcome.

   

  It was a very unpopular choice.

   

   

  • 5:00 PM
  • 2626 Views
  • 26 eProps
  • 12 Comments