Cesarean Awareness and VBAC Support

A few months back I met a lovely mother at the YMCA where I take the boys for active tots.  Her son was the same age as my older boy, and she was about 37wks pregnant with her second son.  After speaking with her I learned that her first son was born by c-section after a long and gruelling labour, but that she was going to try for a VBAC this time around.  I was happy to hear this of course, and I think she was pleasantly relieved to hear that I had a successful VBAC.  Finding a woman to talk to who has had a VBAC seems to be a difficult task for many other women.

I bumped into her yesterday and her gorgeous new baby, not even a month old.  Of course I was curious how it went, and had even been thinking of her over the last few months.  I was disappointed but not at all surprised to hear that she ended up having a repeat c-section.

Obviously only having spoken to this lady a few times, I wasn't about to go pressing for intimate details about her birth, but I gathered the gist of it was she went into labour on her own (yay!) 10 days overdue, but soon into it decided to have the c-section (boo!) to avoid the same situation she had last time which was a long labour ending in surgery.  I wondered to myself, was she informed?  Was she supported?  Not only by her careprovider, but by those around her.

Why is it so hard to find successful VBAC stories?  This is not the first instance where I have encountered someone who mentioned they were thinking of trying for a VBAC but opted for a c-section instead.  Granted this lady actually went into labour first at least, in most cases the mother just goes ahead and books the surgery ahead of time.

It is not my place to judge individual situations.  But a small part of me cringes every time I hear someone in a possible VBAC situation say they aren't going to go for it, or even if they were but they changed their mind at the last minute.  I don't want this to be taken the wrong way by anyone as I do know many fantastic ladies who ended up in these types of situations, and I'm not going to go unfriending people or making enemies over their choices.  Not to mention the fact that what's done is done, I won't lose sleep over someone else's decision.  But naturally I do wonder, why?  Why did they choose another c-section when a VBAC would have been better for them and their baby?

VBAC aside for a moment, I will never understand why a woman would book a c-section (ok wait, we had booked our first one so I guess I do understand from a certain point, but now that I am the wiser I would not do it).  Like with breastfeeding, I will respect that women have the choice, but in most cases I won't understand why they would choose surgery over at least trying for a natural birth.  The only thing I can come up with is, they were not properly informed.  I know that if I had been, and done my homework, I would not have booked an elective c-section for my first son's birth.

When I was pregnant with our first son, my husband had a client who swore up and down that booking a cesarean was the only way to do childbirth.  Her reasoning?  It was more convenient for her.  She almost had him sold on the idea.

In a VBAC situation, I realize that a lot of women are scared.  Particularly if they laboured the first time and ended up with a c-section, they are afraid of the same situation happening again.  I had the fortune to not have this fear, never having gone into labour my first time around.  I can appreciate that fear is a very strong emotion and driving force when making decisions, especially one where the health of your baby is concerned. 

Of course then there are all other things I hear - the doctor said there isn't a chance at successful VBAC, it's too dangerous with the risk of uterine rupture, first labour was failure to progress and the mom's pelvis was too small so no point in trying again because the same will happen.  I cannot stress how there is so much information out there about these topics that is not being shared, and what women aren't being told is that medical intervention is often what led to their cesarean in the first place. 

I feel that it is a woman's job to be informed when making these decisions, and unfortunately most of them are not being given the proper information and support.  In the case of the lady I spoke to yesterday, I suspect she was under OB care and the doctor said to her "sure you can try if you like" but didn't give her the support or the resources she needed to be successful.  With a proper support team in place, the chances of having a successful VBAC are great.

I think I just have such a hard time wrapping my head around two things:  One is why there are so many cesareans in the first place, and two is why more women aren't offered support for attempting VBACs when it is a known fact that vaginal births are healthier and safer for mothers and babies in almost every instance.  I will not dispute that in rare cases a cesarean birth is necessary, but in the vast majority of situations it could have been avoided with proper knowledge and support.

There is a great organization called the International Cesarean Awareness Network (ICAN) which offers information and support for women planning VBAC, as well as providing awareness about unnecessary surgical births.  I am currently in contact with the Simcoe County branch and am going to become a member and volunteer, so I can help educate and support others about these important and often overlooked topics.

I wonder how many cesareans could be avoided, or how many women would go on to have successful VBACs, if only the right information were being shared.

It is easy for me to sit here and preach about VBAC after having had a successful one.  But I can honestly say that it did not come without research or effort.  If you want it, then learn and do all that you can to make it happen.  If you are indifferent and decide to see what happens, or want to just go ahead book a c-section, make sure you are making an informed choice.  You might find your attitude changes when you realize not only how much better a vaginal birth is for you and your baby, but that you have a great chance of success and are at no greater risk for complications than in any other birth situation.

Back to the topic of my own planned cesarean.  Of course at the time, being far less educated than I am now, I was made to believe that it was the safest thing for my baby.  I now know that it would have been better to at least have let us go into labour naturally before making the decision to have surgery.  I do feel a little guilty for having taken that decision out of my son's hands, and again feel fortunate that we had a positive experience because it could have been worse.  He might not have been ready to be born and as a result had suffered complications.

I feel like I have so much knowledge to give other women planning their births, not just in VBAC situations but even for first time pregnancies.  There is so much information that gets overlooked which could mean the difference between an unnecessary surgical birth, and the natural birth that is healthier for the mother and child.  This was a hard post to write, simply because there is so much information to share, and because I feel so strongly about these topics.  It was hard to organize my thoughts, hopefully I have made some shred of sense in all my jabber.

I found this article really interesting on the topic of risks associated with VBACs:  VBAC: making a mountain out of a molehill (be sure to watch the video at the end, it is so heartwarming and empowering, and I cried all the way through it)

The bottom line, the choice is personal, but make sure it is an informed choice.  The natural start of labour and a vaginal birth is how nature intended babies to be born, and it is a healthy and safe choice even in a VBAC situation.

Everyone Has to Start Somewhere

I could sit here and write out every detail surrounding my two pregnancies and births in the order in which they happened.  I could probably fill pages with this kind of stuff and would gladly share my stories with you any day.  But it might bore you to death.  If you were interested in reading a bit more about this kind of stuff, I have touched on it on my other blogs.  You can find it all here:

Life on the Bay - Finn's Pregnancy

Life on the Bay - Finn's Birth (VBAC)

Dear Children, Love Mommy - Tristan and Finley Birth Stories

As I have briefly mentioned, I did not put a lot of thought into my first birth.  I read about labour, the stages of it, and the options for pain management.  I knew early on that I wanted a natural birth, free of medications that might harm me or my baby.  But midwife care vs OB care?  Hospital vs home birth?  Cord clamping and cutting?  Birth plans?  How to breastfeed?  Fetal positioning?  Nutrition and exercise?  There was so much information that got overlooked.  I guess I just figured it would all play out, that I didn't have to do anything to prepare.  Sure, we took our Hypnobirthing classes (with Jennifer Elliot from Life's Journey) and we did learn a lot, but somehow so much of it went over our heads, like we somehow didn't need that knowledge because it would just fall into place.

When I found out I was pregnant, my first move was to see my family doctor.  I was curious about midwife care but didn't know anything about it (and assumed that I would need a referral as with an obstetrician).  I enquired about midwife care through my family doctor and she really did not have any information for me but said she would look into it.  A few weeks later the only thing I heard from her was that she referred me to an OB and my appointment was booked.  I figured that was that.

I was under OB care for the first two trimesters of my pregnancy, and never felt satisfied.  It's not that she was doing anything wrong per se, it was just so....impersonal and cold.  I would go there, the receptionist would hand me my stick to pee on and tell me to bring it back.  She would check it, write down the results, then I would sit and wait.  The waiting room literature consisted of pamphlets about cord blood banking, and long outdated fashion or home magazines, with maybe a parenting one thrown in.  Finally I'd get called in, the receptionist would weigh me, then I would wait in the examination room for the doctor.  She would usually come in, head down reading my file, rush over and feel and measure my belly, listen for the heartbeat quickly, then rush back out again.  Sometimes she'd ask if I had questions, and other times she was gone before I could say a thing.  If I did have a question she gave me this look like I was ridiculous.  It was not a particularly enjoyable experience, not to mention the fact that under OB care your baby is not guaranteed to be delivered by your own doctor, rather it would be whoever was on call, and I was not really comfortable with this.

It wasn't until 29wks pregnant that I wised up and switched to midwife care.  We were moving anyway so I took the opportunity to make sure I was under the care of someone I trusted.  We were fortunate that the practice took us so late in our pregnancy, but they accommodated us no questions asked, and from the minute I stepped into their office I knew this was the care I wanted.  It was open, bright and comfortable, with shelves of books about pregnancy, birth, breastfeeding, parenting, and everything in between.  The atmosphere was warm and inviting.  You peed on your stick and relayed the results to the midwife yourself, not having to hand it into someone else to look at (gross!).  There was a scale in the bathroom if you were interested in how much you weighed, but it was not necessary to use it. 

When I would go to my midwife appointments, I never felt rushed.  We would sit and just chat.  She would always ask me if I had any concerns.  She would listen to the heartbeat if I wanted, but didn't make a big deal about it being necessary.  She had so much more information for me than I ever hoped to get out of the OB

Not that I would say having an OB is the wrong choice.  For many women pregnancy holds complications and being under OB care means peace of mind.  And I am certain that so many doctors are warm and inviting, and offer more information to their patients.  But the choice between OB and midwife care was just one more thing that had I been more informed and done more research from the start, I would have done differently right away.

A healthy woman with an uncomplicated pregnancy should consider midwife care.  Birth need not be a medical event, and unfortunately all too often it becomes one when medical interventions are offered with what would otherwise be a normal, healthy pregnancy. 

Now, in my case even with midwife care, medical intervention was still present and was a huge factor in how my son was born.  I do not in any way think it was anyone's 'fault', but I do find it interesting to think about the circumstances and what could have been different.  While I felt very comfortable with my midwives and was happy with their care, something stands out to me now after having gone through pregnancy and birth with another practice.  As I have mentioned, my son was breech, and we wanted to try a technique called a External Cephalic Version or ECV.  I had done a little bit of reading about the procedure and from my understanding it would usually be done without any type of medications, and although uncomfortable it is not generally considered painful.  I had also heard through a friend who was also pregnant with a breech baby, that the midwives at her practice performed the versions themselves.  At my practice they did not do them, and referred me to an OB at the hospital who did.  When I met with her I was told that it would be painful, and therefore they recommended performing it under epidural anesthetic and also scheduling a c-section at the same time so if the ECV failed they would go ahead and deliver via c-section.  Additionally, if it did work they would go ahead and induce me the same day.

Well you can imagine that this was not what I wanted, and did not sound right to me.  But at that point I felt like I was entirely in the hands of the OB, and she more or less told us that it would be too dangerous to allow me to go into labour with a breech baby.  When I asked about having the ECV without the epidural, I got a bit of a "tsk tsk" and "Well, you can....but I would not recommend it".  For me, with my limited knowledge from what I had read, I was almost ready to stand my ground.  But my husband, who had not read a thing, was of course ready to follow everything the OB said.  And I did have to respect his wishes too.  I was not nearly as informed then as I am now, and as new parents we only wanted what was best for our baby (according to what the doctor said).

I think what surprises me the most here is that in this case the midwives did not have more to offer.  I know now from talking to others, from my own research, and from my experience with a different midwife practice that this should not have happened.  I should have been more informed.  Someone should have said to me "it would be better for you and your baby if you wait to go into labour", or "you do not have to do this if it's not what you want".

Also at the time, to attempt a vaginal birth with a breech baby was not entertained.  I might have tried, if someone had said to me "You can do this, we can do this" and had been confident in it.  But I was given a flat out no.  I do know that there were practitioners who may have tried, but I didn't know where to find them at the time. 

After my son was born though recommendations have changed, and I am happy to hear they no longer automatically suggest booking a c-section for a breech baby.  A trial of labour is recommended providing there are no complications.

Of course I do not blame anyone for anything.  If anything I should have been more informed myself.  I was clueless at the time, and my lack of knowledge led to a lack of voice to stand up for what I would have wanted.

I am happy to report that although our ECV failed and they were unable to turn my son around, I did have as wonderful a c-section experience as one can hope.  There is always a bright side, and ours it that everything went smoothly, and both my son and I were healthy and had no complications.  I have learned from this experience, learned to be more knowledgeable when important things are at stake.  And this is one part of what makes me want to be a doula, so that I can inform others and help them to find their voice.