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VBAC: You Don’t Have to Have a C-Section

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By Chris Egan

Almost two months ago, my wife had a successful VBAC (Vaginal Birth After Cesarean) and we welcomed our baby girl into the world. She, like many expectant mothers, experienced an enormous amount of pressure to have a medically unnecessary c-section and had to fight to give birth the way she wanted—the way she felt was best for her and the baby.

2 ½ years ago we welcomed our son into the world. My wife had planned to have a natural birth but after 24 hours of labor and over 2 hours of pushing, our baby was stuck. She would have continued pushing but the baby’s heart rate was rising because of a Chorioamnionitis infection caused by his passing of meconium. We were being cared for by a group of Midwives, so they called in the OB to examine my wife, the baby, and the situation. She recommended an emergency C-section. We agreed that that was best for baby and momma and before we knew it we were under the bright lights of the operating room and he was out, healthy and happy, delivered by Cesarean.

Recovery for her was hard. A C-section is major surgery. For the procedure, a woman is given regional anesthesia, usually via an epidural or spinal block. The abdomen is cut open, usually with a horizontal incision below the bikini line and then another incision is made on her uterus. The baby is removed, the cord is cut, then the baby is examined and usually given to the mother for skin to skin contact while the surgeon and medical staff complete the procedure, which involves removing the placenta, a lot of suctioning, a few stitches or staples, and bags of blood littering the floor—at least in our case. The entire procedure from incision to sutures can last over an hour and, again, in our case, there was no immediate skin to skin contact because my son had passed meconium during labor. This meant it took a lot longer to clean and examine him, but eventually they gave me my son so I could take him to my wife while the surgeon completed the procedure.

Our son is now a spirited toddler, almost three years old, and is the light of our life.

When we found out my wife was pregnant with our second child, she had already decided that she would attempt a VBAC. Hell, she had made that decision before we left the hospital with our son. 90% of women who have a C-section end up having another one with subsequent children. My wife was determined to be a part of the 10% that don’t.

We went back to the same group of Midwives that had cared for my wife during our first pregnancy. They were supportive of my wife “trying” for a VBAC but were open about the risks and the likelihoods.

But as the due date approached, we began getting mixed signals. Our now weekly visits to the midwives brought on different answers depending on who we saw that day. One midwife told us the plan after reaching 41 weeks would be to induce labor using low-dose Pitocin. Another said, “oh no, we wouldn’t risk inducing labor since you’re a VBAC.” To be fair, the midwives work in collaboration with a group of obstetricians, and toward the end of my wife’s pregnancy, they started working with a new group of OBs. They said these mixed signals were largely based on differences in principles between their former obstetricians, who were more conservative, and their new ones. The new group was open to more progressive practices such as induction by low dose Pitocin for VBAC candidates.

The due date, June 24th, came and passed and my wife was scheduled to be induced at 9 am on July 3. Our hope, of course, was that she would go into labor naturally before then but on June 30th, with our window of opportunity closing, my wife received a call confirming her appointment for induction. On that call, they also informed her that she shouldn’t eat anything after midnight because her C-section was scheduled for 9:30 am.

Their plan was to check her cervix to see if it was “favorable” at 9 am and if it wasn’t, they would wheel her back for a C-section at 9:30. As of Thursday, June 29th, her cervix was not favorable.

This caused a great deal of anxiety for my wife at a time when she was already uncomfortable and looking for ways to stay positive. We hadn’t requested to be scheduled for a C-section. We hadn’t authorized it. It wasn’t a part of our birth plan. Nobody suggested it as an option and asked what we thought. They just scheduled it without consulting us, assuming that we would comply without question.

Well, we had questions.

My wife decided she was going to call the hospital and the midwives on Monday morning, July 3rd, and tell them, simply, that she wasn’t coming (unless she had gone into labor by then) and they should cancel both the induction and the C-section.

You see, my wife is amazing. She is smart, stands up for herself, knows her rights, knows her risks, sets herself up for success, and maybe most importantly, she knows how to build a support system. In addition to the midwives, she had been working with a Doula. Before making this call on Monday, she consulted with her Doula to see what would happen after refusing their recommendation. Would the Midwives refuse to see her and care for her? Would the OB refuse her care? Obviously, if she showed up to the emergency room in labor they would care for her, but we still wanted the support of the midwives. Overall, and up to this point, they had been great. She just wanted to know what, if any, repercussions would occur for refusing the induction and C-section on this date.

I should point out that my wife was very uncomfortable at this point in the pregnancy, and that is probably putting it mildly. It was the middle of summer, she was hot, sore, and ready to hold our baby in her arms. But the goal was to have the baby naturally and my wife knew she would not be taking any significant risk to her or the baby by waiting a few days longer to give her body the chance to go into labor on its own.

She wanted to avoid being induced because, as you often hear, “one intervention leads to another intervention.” This means that with each unnatural intervention used in an effort to help move the labor and delivery process along, the odds that labor will need additional interventions increases. The result at the bottom of this slippery slope is, of course, a C-section.

On July 3rd my wife was 41 weeks + 2 days pregnant. We knew that, statistically, risks increased after 42 weeks, but we weren’t there yet so on Monday, July 3rd, my wife called the midwives and told them to cancel her induction (and the C-section!) because she would not be coming in. She told them she is not ready, hasn’t gone into labor yet on her own, and would like to give her body the chance to do just that.

They asked her to come to the office as soon as possible for a consultation, to which we obliged.

After explaining the same simple basis for her decision to the midwife in the office, she asked if it would be alright if she checked my wife’s cervix to see if she had progressed since her last appointment, which was just a few days prior. It turned out that she had progressed, which told us that her body was getting ready. The midwife said she would have to consult with the supporting OB group and asked us to wait. She came back a few minutes later and told us that the doctor still wanted my wife to go in for an induction “today”. Our midwife said she concurred.

We said no.

My wife told them she would be willing to come in for an induction on Friday, July 7th if she hadn’t gone into labor naturally by then. We had just had a non-stress test and knew that the baby and momma were perfectly healthy, but we suggested we go in for another to make sure nothing had changed.

The midwife reiterated the risks, uterine rupture, which is present with any VBAC, and the possibility that her placenta would “stop working” and we could end up with a stillborn baby— which really just seemed like a fear tactic considering nobody mentioned that to us at the 41-week check up for our son who was born 12 days late. Nevertheless, we thanked her for reiterating the risks and she scheduled our induction for Friday.

We went home.

Tuesday came and passed, then Wednesday and Thursday—nothing.

On Friday morning we nervously went in for my wife’s scheduled induction, dealing with a series of what—at the time—seemed like frightening omens telling us to turn around and wait longer: our son tantrumed as we tried to load up the car—not unheard of but he had been fairly well behaved for car rides recently. A concrete truck blocked the road leaving our neighborhood and then a car fire blocked the road as we approached the hospital causing a last minute reroute. Not the kinda thing you want to run into ever, let alone on the way to the hospital to have a baby.

But, we knew that waiting any longer, statistically, increased the risks by a significant amount (Though there is debate over these statistics as well). My wife was induced on Friday morning around 10 am with low dose Pitocin and by Saturday morning shortly before 4 am, our sweet girl was born—a successful VBAC.

To be clear, I’m not saying anyone should simply ignore the advice of their health practitioners—usually, they know best. But sometimes you have to be your own best advocate. If you have taken the time to educate yourself and you know there are options that prioritize your unique needs and interests better than the general recommendation, without putting your or your baby’s life at risk, you can speak up. You can get a second opinion. You can say no, that’s not what I want. You can say, “That’s not best for me and my baby.” 

However, if there any biological signs that are telling you or your doctors that things aren’t exactly right, or if you have been told that you are not a good VBAC candidate and risks for you are higher than the average VBAC candidate, then without a doubt, I think you should take your doctor’s recommendation. 

My wife had multiple nonstress tests in the days leading up to birth and they all reported that both baby and momma were in perfect health. She had also done extensive research on the risks involved in attempting a VBAC. She consulted multiple professionals—her doula, my mother (a registered nurse of 20+ years), and her step-father (also a nurse)—not to mention the rest of her family and friends who, while they aren’t health practitioners, were able to offer additional advice. In other words, she made an informed decision, not a careless one.

I am not writing this to attack the medical community—we received wonderful care and support from the midwives, doctors, and hospital where my wife labored, gave birth, and recovered. We are very grateful for everyone who helped us.

I am not writing this to attack women that choose to have a C-section. I have immense respect for women that make this decision too. Everyone should make their decisions based on their own needs, beliefs, and on the health and safety of the baby and her mother.

I am not writing this to dismiss the C-section as a viable procedure. Obviously, the procedure has saved countless lives.

And I don’t mean to gloss over the hard work my wife went through in labor that day—it was her knowledge, preparation, hard work, determination, and confidence in the miracle of her body that culminated in a successful VBAC and a healthy baby.

But I am writing this to add to the story of all births in the U.S. today. Are all women aware of the options they have when making a birth plan? Can we provide mothers more information on how to find a Doula? Are all women aware of the rights they have when a doctor or a midwife prescribes a treatment or a procedure regarding their body, their baby, their pregnancy? Do they have up to date statistics? Can we do better?

I think we can.

I am immensely proud of my wife for being so strong. I know that more women have that capability first they have to know that they are already empowered. They have to know that they have the power of choice, the right to a second opinion, the power to self-educate, and the right to say no. The C-section is not a one-size-fits-all option for giving birth.

Be sure to fully understand your risks, before exercising your rights. But know, you can say “no, that’s not the best option for me. What else can we do?” 

For More Information on VBACs:

VBAC Facts

6 Ways Doulas Can Support Families Planning VBACs.

Elle Article on Hospital’s stance on VBACs

American Pregnancy Association VBAC facts

 

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