The C-Section and the VBAC

My daughter and I, minutes after my VBAC

Seven months after my son had been delivered via C-section, long after I thought I’d recovered from the birth, I read an article in our local newspaper that brought back all of the pain and difficulty surrounding my surgery. In an article featuring the first area baby born in 2010, the new mother, who had evidently had a vaginal birth,  was quoted as saying, “Natural childbirth is not nearly as hard as it seems. It takes focus and dedication and the end result is well worth it.”

Focus and dedication. I was in labor– and by that I mean strong, regular contractions– for nineteen hours prior to my C-section. In those nineteen hours, I never dilated past five centimeters (you must reach ten in order to deliver a baby vaginally) and my son never dropped into the birth canal. After performing the operation, my doctor noted that my son was in an “asynclitic posterior” position, meaning he faced my front instead of my back and his head was cocked to the side, making it basically impossible for him to descend. A midwife friend referred to it as a “perfect storm” of circumstances working against a vaginal birth. Everyone agreed the C-section was necessary and I had reached a point where gratitude for medical technology had trumped disappointment. But on some level, the woman’s comment still stung.

“Next time I will try to be a bit more ‘dedicated’ to having my baby,” I wrote bitterly in an e-mail to a friend. What I really meant, of course, was that it isn’t always about dedication. If it were, then surely those nineteen hours of hard labor, preceded by birth classes and prenatal yoga then accompanied by a caring husband and wonderful doula, wouldn’t have resulted in surgery. But they did.

When I became pregnant with our daughter, I knew I wanted to attempt a VBAC (Vaginal Birth After Ceasarean).  There are some risks associated with VBAC, but they are relatively rare (the risk of uterine rupture, for example, is just over 1%), and repeated  C-sections can also be risky– arguably moreso. The American Congress of Obstetricians and Gynecologists recommends VBAC as “a safe and appropriate choice for most women who have had a prior cesarean delivery.” Yet had I continued receiving care at the same Michigan hospital where I gave birth to my son, I would not have been allowed to attempt a VBAC. Though many U.S. hospitals do permit VBACs, restrictions against such births are fairly common as well; my German midwife said that most of her American patients who had C-sections would not have been allowed to try a vaginal delivery at their home hospitals either.

Germany’s C-section rate is actually just a tad lower at 27.6% than the United States’ 30% (both figures are nearly twice the rate recommended by the World Health Organization; to the WHO’s concern, developed nations as a whole have seen recent spikes in C-section rates), but I did see several OB doctors here and found the attitude toward VBAC very positive; in Germany, the medical “norm” is to attempt a VBAC.

My midwife and OB were very committed to helping me towards a successful VBAC; as I’d experienced complications with my placenta in the third trimester, my OB performed frequent tests to ensure that my risks of rupture or other complications hadn’t increased as a result (they hadn’t). When I still hadn’t gone into labor several days past my due date, my OB said he wanted to wait longer before inducing– “your body doesn’t seem to be ready for labor yet,” he said after doing the regular checks, “and if we try to induce you before your body is ready, we run a higher risk of C-section.” Nine days after my due date, when I finally was induced under more favorable physiological circumstances, it was not with a Pitocin IV but rather what my OB and midwife called a “cocktail”– a sort of smoothie consisting of apricot juice, verbena extract, ground almonds, castor oil, and vodka (contractions started within an hour after I drank it).

Throughout labor, my midwife, who knew my history and the result of my previous labor, provided excellent guidance. Five hours in, when I still hadn’t dilated past 4 centimeters, she recommended an epidural. I’d already had two days of painful but irregular contractions prior to the induction and during my previous labor, dilation had been destructively slow. “We want a vaginal birth,” she said. She then knelt down to look me in the eye (I was in the tub at the time), and said, “You don’t need to be a hero. The epidural is here if you want it.”

I took the epidural, dilated to 10 cm within two hours, and delivered a healthy baby eight hours after contractions started. The differences between my two birth experiences are so vast they are difficult to articulate. During the C-section, I felt disconnected from my body and even from the baby at first; after he came out, they wrapped him in a towel and simply showed him to me; I actually had to ask if I could at least touch him. Though my doula eventually brought him to me to nurse, I don’t remember it.  As soon as a final push brought my daughter into the world, the midwife swept her up to my chest, where she nursed almost immediately. After the C-section, I was trembling uncontrollably from anesthetic–so much that I couldn’t really hold my baby– and experienced incredible pain that I couldn’t relieve because I had to lie flat on my back until it wore off. After the VBAC, I felt energetic and elated. It took me a week to feel like I could really walk normally again after my C-section; I walked without difficulty the night of my VBAC.

Considering these benefits, of course I’m thankful for my VBAC. What might sound strange is that I’m also thankful for my C-section. I wouldn’t go back and turn that into a vaginal birth if I could. And I don’t like referring to my VBAC as the “natural” birth– what does this make my C-section? Unnatural? I carried a baby in my womb for nine months and he emerged, alive and well. Would it have been more “natural” for us both to have died, as we might have if I’d been laboring in the 1800’s instead of in 2009? As significant an experience as birth is, what matters much more than how the baby came out is, of course, the baby itself, and I have been doubly blessed with my two children.

Still, experiencing both births has made me empathetic to women with all kinds of birth stories and has taught me a lot about how much control we actually have over the mysteries of birth. We can plan obsessively and do everything we think is right and end up with an experience we never expected. So in place of resentment we must find room for acceptance, for learning. What better preparation for parenting– a task that demands earnest preparation but also total spontaneity and constant adjustment? Khalil Gibran wrote: “Your children are not your children… / They come through you but not from you, / And though they are with you yet they belong not to you.”  And just like my children, my C-section and my VBAC, though definitively mine, were not entirely predictable nor within my control. Certainly it was helpful to have an experienced OB and midwife who were dedicated to VBACs, but I don’t necessarily think that my first birth would have been a vaginal one even if it had happened in Germany. After all, on the day of my VBAC, my midwife was helping another woman through labor but ended up assisting during her emergency C-section (the baby had gone into distress). At one point in my pregnancy, as I discussed my fears about labor with my midwife, she sympathized: “Sometimes it just happens that a C-section is needed, even when we never expected it. And that’s frustrating for everybody.”

I don’t suppose the self-assured woman in the newspaper would understand this. Come to think of it, since I had an epidural, she might not even consider my VBAC “natural childbirth.” She might have thought I just needed a little more focus.

But I know better.

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10 thoughts on “The C-Section and the VBAC

  1. This made me cry – as you can imagine, you have written so elegantly things that have always been too hard for me to share. hugs – tean

  2. As someone who labored for 40 hours, hoping for a VBAC, and finally had a C-section…whatever choices you made were right, always right.

    (My husband had been reading “Into Thin Air” about the Everest ascent that went awry, and it was after hearing about someone who turned back in the climb when he heard about the bad weather conditions…that’s about when I figured it was time to let the C-section happen. And after my son was born, my first “night out” alone was to go hear climber Lou Kasische talk about that climb, and his decision to stop 400 feet from the summit. Most of the others who pushed on didn’t survive. Sometimes the bravest act is to decide not to “go for it.”

    1. Ruth, I completely agree– the element of choice in labor, whether that means surgery or not, is essential. A friend of mine once said it bothered her that people automatically viewed a C-section as meaning a woman was somehow not empowered during her birth. In my experience, and clearly also yours, the opposite is true– a C-section can be the desired, informed, correct choice. Besides, my VBAC was a matter of luck, not some kind of “choice.” It could just as easily gone the other way– I certainly wouldn’t have had the courage to labor for 40 hours. Your mountain climbing analogy is quite accurate. Thanks for your insightful comment.

  3. Sarah, I was just catching up on your blog– I can’t tell you how often I run into something similar to the quote you cited, and it is great to hear your response. The idea that one birth is somehow more “valid” then another is so absurd, but I think is said without thought by people who have had different experiences. My experience with Zoe was about identical to yours with A, and I sometimes struggle with “what if-ing”….very well said!

    1. Thanks for that comment, Carey. I know you had a similar experience with Zoe and that you know where I’m coming from. After having the two different birth experiences I had, I can most definitely say there was nothing *I* did to get either the C-section or the VBAC. They just happened that way. I wish could feel empowered about their births without feeling such guilt when they need a C-section. And you’re right, it’s definitely easier for people who haven’t gone through unplanned C-sections to think that they were in completely control of their birth experience. But really, theirs were just as mysterious as ours!

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