Vaginal Birth After Cesarean; by Jasmine Maes, LM, CPM
I am writing both from the perspective of midwife and from that of a birthing woman. I had been a midwife for eight years when I learned I was pregnant with my first baby. I felt confident and supported. I planned for the homebirth of my dreams. I encountered some complications of pregnancy at 37 weeks and agreed to a hospital induction of labor. After 40 hours, many tears, a whole lot of Pitocin, and very little sleep, I agreed to a cesarean birth. My amazing son was born, and I was relieved and in love, and absolutely heartbroken. How could I, an experienced midwife, allow such a thing to happen to me? I felt harmed and tricked, and sadly my story just sounded cliché, an all too common tale. I spent countless hours deliberating which decision might have allowed me to birth my son the way I had envisioned. My body wasn’t ready. That tub was so shallow. Was I really that sick? Was the induction even necessary? What if I had been able to keep going without an epidural?
With my second pregnancy, I was determined from the start to give birth vaginally. I did not fear labor, uterine rupture, or having another cesarean birth. I just knew that I needed to be left alone. I absolutely needed to be at home. I needed water that was deep and hot. I needed privacy. I needed my husband to believe me and believe in me, and hold me through every contraction. I needed experienced midwives around me to keep the birth room safe and peaceful.
I went into labor several days after my due date. I had mild regular contractions during dinner and went out for a walk with my husband and our son. By the time I reached the bottom of our hill, I called our midwives. Soon after, I was moaning and leaning over the stroller, I still had to make it back up that hill. One of the midwives agreed to come over and listen to our baby and check in. As I reached the driveway, my water broke, and the midwife arrived. She and my husband filled the birth tub and just 5 short hours later, our baby girl was born. Birth works. It is powerful and true, and in my opinion it is as safe as life gets. Even with a previous cesarean scar.
Many families are surprised to hear that VBAC is “allowed” or even possible in Sonoma County. Though some hospitals do not allow or support a woman’s decision to birth vaginally after a previous cesarean, the Thrive midwives have had the experience of supporting women through this journey for many years. Midwives have long been the guardians of successful VBAC. Our patience and trust in birth are key elements in any birth, but are crucial for the woman desiring a VBAC. Freedom of movement, emotional and physical support, effective relaxation through hydrotherapy, and choice of birth position are essential in a VBAC experience. So is the ability to allow labor to unfold in its own unique way, free from the confines of time limits and protocols, free from the supervising eye of the surgeon.
Myths and realities abound around the risks of VBAC and uterine rupture. In just a few minutes of research, I found what I was looking for. Lots and lots of numbers. The risk of uterine rupture is higher in women with previous cesarean scars, that fact cannot be argued. And what about the risks of repeat surgery? Increased chance of hemorrhage, infection, organ damage, placental complications in future pregnancies, increased pain and recovery times, and breastfeeding challenges. I encourage you to look, the results are fascinating.
But numbers aside, the overwhelming reality is that vaginal birth after cesarean is considered an acceptable option for women who have access to emergency medical care when necessary, and that is not necessarily defined as birth in the hospital. The National Institutes of Health found inconclusive evidence to support the recommendation that women desiring a vaginal birth, labor in a hospital with 24 hour surgical staffing. With Thrive’s optimal location near two major surgical centers, we have better access to emergency care than many women living in a rural area, or birthing in a lower volume community hospital. Women should have the choice to birth vaginally and be supported in this choice, wherever they feel safest.
Since our opening a year ago, we have had 5 healthy and victorious VBAC deliveries at Thrive! There is something so healing and inspiring about watching a woman discover her own power through birth. Amazement as she reaches down to feel her baby emerging, disbelief that her body knows just how to do this. It reminds me why I love being a midwife, and of my own journey to motherhood. Serving the courageous women and families in our care has helped me to see my son’s cesarean birth as a treasure, an experience of value that has allowed me to connect with so many women on a vulnerable and deeply emotional level. For months after his birth, I wished I could go back and do it all over again. Now, I wouldn’t trade that experience for anything in the world.
www.VBACFACTS.com – an awesomely researched and un-biased site with tons of information and studies on VBAC
consensus.nih.gov/2010/images/vbac/vbac_statement.pdf – The National Institutes of Health Consensus Development Conference Statement on Vaginal Birth After Cesarean: New Insights
www.ICAN-online.org – International Cesarean Awareness Network
www.uptodate.com – widely referenced by physicians