Mom defies doctor, has baby her way

This is an amazing, inspiring, and interesting article! Please read!!  Here is the link: http://www.cnn.com/2010/HEALTH/12/16/ep.vbac.birth.at.home/index.html

(CNN) — On Thursday, December 2, as Aneka sat at home nine months pregnant, the phone rang.

It was her obstetrician wanting to know where the heck she was. Did Aneka forget that today was the day for her cesarean section? How could she have forgotten?

No, Aneka hadn’t forgotten. She hadn’t shown up intentionally.

“She told me, ‘You’re being irresponsible. Your baby could die. You could die,'” Aneka recalls. Then the doctor hung up.

Aneka (she doesn’t want her last name used) had already resolved to not have a C-section, even though the doctor told her it was absolutely necessary. She wasn’t going to be opened up surgically, no matter what her doctor said, no matter what any doctor said.

In some online communities, Aneka is a hero who defied the obstetrical establishment and gave birth her way. To many doctors, however, she’s a risk-taker who put her and her baby in peril by giving birth at home.

‘No, no, no, you can’t do this’

Aneka’s story begins nine years ago with the birth of her first daughter, Nya. After 10 hours of labor, her doctor told her she wasn’t progressing quickly enough, and she needed a C-section.

“I didn’t know any better, so I said OK,” Aneka says.

In a postpartum visit six weeks later, the doctor told her she’d needed the surgery because her hips were too small to pass the baby.

“I thought to myself, what’s she talking about, I don’t have small hips,” Aneka remembers.

Four years later, doctors told Aneka she couldn’t deliver her second child vaginally, since Nya had been delivered by C-section. Studies show when a woman gives birth vaginally after having had a previous C-section, there’s a higher chance her uterus will rupture since she’s pushing against scar tissue.

Then again, when Aneka was pregnant with her third child, son Adasjan, she had a C-section for the same reason.

When she became pregnant with her fourth child, a boy named Annan Ni’em, she expected to have a fourth C-section. But about seven months into her pregnancy, Aneka started to read more about childbirth online, and noticed a documentary by actress Ricki Lake called “The Business of Being Born,” a film released in 2008 that questions the way American women have babies.

“I was a little bit angry after watching documentary,” she said. “It made me realize I’d been robbed of the birthing experience. If possible, all women should be allowed to birth naturally.”

“I asked my doctor if I could try delivering vaginally, and she said no,” Aneka says. “I called the hospital and they said they wouldn’t allow it, and I called three other hospitals and they wouldn’t let me deliver vaginally, either.”

The closest hospital that would let her try to deliver vaginally was in Manassas, Virginia, about 90 minutes from her Maryland home. She and her husband, Al, decided that was too far.

So just seven weeks away from her December 1 due date, Aneka contacted the International Cesarean Awareness Network, an advocacy group that promotes vaginal births after cesareans, or VBACs.

“She asked me if I could find someone who would deliver her vaginally,” remembers Bobbie Humphrey, who works with ICAN. “She started to cry because she’d heard ‘no, no, no you can’t do this’ so many times.”

But Humphrey told her yes, that she knew of a midwife who would be willing to deliver her baby at home.

An article in Midwifery Today, written by Barbara Stratton, the National VBAC ban chair for ICAN, lists several approaches women have used to protest a VBAC denial.

On December 5, three days after the C-section that never took place, Annan Ni’em was born at home. He weighed 9 pounds, 6 ounces and was delivered after 20 hours of labor, and, she says, just four minutes of pushing. He was completely healthy.

“We were all crying at the delivery,” says Humphrey, a doula who assisted the midwife at the birth. “It was very emotional. I was just so proud of Aneka.”

Soon, word spread on e-mail lists and chat rooms about the healthy delivery.

“People were e-mailing Aneka saying ‘congratulations, you’re a role model,” Humphrey says.

“Potential for catastrophe”

Vaginal births after cesarean sections pose some risk, but so does having another cesarean. After weighing the risks of each, the American College of Obstetricians and Gynecologists came out with a statement earlier this year saying it’s reasonable to consider allowing women who’ve had two C-sections to try to have a vaginal delivery.

The group added that there’s limited data about what should happen with women, like Aneka, who’ve had more than one previous cesarean.

Despite the ACOG statement, many doctors and hospitals refuse to do VBACs because of the risk. Women who try to deliver vaginally after cesarean have between a 0.5 percent and a 0.9 percent chance of having a uterine rupture — a potentially deadly complication for both mother and baby, according to the American College of Obstetricians and Gynecologists.

Women with two previous C-sections have a 1 percent to 3.7 percent risk of a uterine rupture, according to ACOG.

Studies show the risk for a uterine rupture goes up if the woman’s labor is induced. Aneka’s was not.

Dr. Jeffrey Ecker, a spokesman for ACOG and director of obstetrical clinical research and quality assurance at Massachusetts General Hospital, warns against reaching too many conclusions from Aneka’s successful VBAC at home.

“Anecdote is no way for folks to make plans,” he says. “Just because something turned out well for one patient doesn’t mean there are no risks and it will turn out well for you.”

He says there’s a reason that uterine rupture is more likely when a woman’s had a C-section.

“You cut into the muscle of the uterus during a cesarean, and it heals with a scar that is often weaker than the muscle that was there before surgery,” he says. “The scar can be weak enough that the contractions cause it to separate.”

In that case, blood flow to the placenta can be interrupted, and the baby doesn’t get enough oxygen.

In its latest position paper, ACOG recommended that VBACs be attempted “in facilities with staff immediately available to provide emergency care.”

“There is potential for catastrophe if [a uterine rupture] happens in a home environment,” says Dr. William Grobman, an ACOG spokesman and associate professor in the Department of Obstetrics and Gynecology at the Feinberg School of Medicine at Northwestern University.

Grobman says he understands Aneka’s desire not to have another C-section.

“This was a last resort. This was a choice because she had no other options,” he says.

But Aneka says if she has another child, she’ll give birth at home.

“Once you have that experience there’s no other way to go, being in the comfort of your home without any unnecessary interventions and feeling like you’re in charge,” she says.

VBAC Doesn’t Make it All Better :(

This article is from http://www.theunnecesarean.com/blog/2010/3/31/vbac-doesnt-make-it-all-better.html

By Emjaybee (from www.unnecesarean.com)

The most common thing I heard from everyone, doctors, nurses, midwives, friends and relatives, when I told them my awful c/section story, was, “Well, next time you can have a VBAC!” 

Well, no actually. I’m not planning to have another child, and that probably won’t change.

And even if it did, what does it do to a woman to say this to her? It tells her “OK, well, you failed, but you can try again!”

And there are so many things wrong with that attitude I hardly know where to start. Here, let’s make a list:

Erasing the grief

A woman who has had a traumatic birth, c/section or no, is in grief. The more she tried for a good birth, the more she cared, the more she believes in healthy empowered birth, the more she is going to grieve. The more she feels her rights were not honored, the more she feels she was assaulted, the more she feels she was treated as less than a full person, the more she will grieve.

And she needs to grieve.  And she needs her grief to be honored. Birth is a transformative event to many women, and the Story of How You Were Born is something mothers are supposed to be able to give their children.

But if that story is full of pain and trauma, she will not be able to tell all of it to her child. There is a lot she will have to leave out, to keep in silence, at least until the child is grown enough not to be traumatized by it; most women won’t tell even then.

All of that is a loss, and that loss cannot be erased by anything, because there is nothing that will make it Not Have Happened. It happened. It exists in her history, it is part of her memories, and most painfully, it is tied up in otherwise wonderful memories that she treasures of her child’s arrival.  Unless she wants to forget the first few days of her child’s life, she does not have the luxury of forgetting her trauma either.

Implicating the woman

A woman who  has had a traumatic birth has not failed, but she has been failed, either by her own body, or by the system. Both are painful.  A woman failed by her body may feel broken, incomplete, less than a full woman, even feel shame, even as she knows it’s not  her fault.  A woman who was coerced and pressured into a c/section, on the other hand, may feel stupid, weak, foolish, and ashamed that she let it  happen to her, even if she knows it is not her fault. Much like any accident survivor or assault victim will often have periods of blaming themselves.

So when others place all the focus on having a VBAC, what they may not realize they are also doing is agreeing with these viewpoints—agreeing that yes, she just needs to do things differently next time and hopefully, that birth will be a “good” one.  Because this one so clearly wasn’t.

Making it about the listener

Look, I know that telling my story is hard on other people; it’s hard on me. I don’t enjoy it and I don’t tell it without cause.  But if I am telling it, especially if the listener asked to hear it, I expect the listener to do me the courtesy of dealing with their own discomfort.  In other words, sure, it does make the listener feel better to tell me I could have a VBAC, because then, they can move on from thinking about my bad experience to thinking about an imaginary good experience I might have in the future. I understand that, but it’s disrespectful to me and to other women telling their stories. We need listeners who will not rush to gloss things over or urge us to think happy thoughts, but who will endure, as we endure, thinking about the sheer awfulness of what happened to us, at least for a little while.

Ignoring negative possibilities

What if a woman does try for a VBAC, but doesn’t get one, for whatever reason? Is she supposed to keep trying till  her uterus can’t take any more? And how will she deal with the newer pain and disappointment she feels after a CBAC? Or what if she can’t try for a VBAC for infertility, or other, reasons? Will her friends and supporters just feel uncomfortable and drop the subject now that there’s no chance for the happy ending? Or will they be with her in her pain, be angry with her, believe in her, accept her as she is, non-triumphant?

Making the political merely personal

This one is the biggest concern.  Because the response to an injustice should not be “here are ways you can do happy related things to make you forget the injustice” but “let’s change this system of injustice so it doesn’t keep happening.”  I was coerced for no medical indication whatsoever, into an induction that led to a c/section, one that increased my risks of mortality and was traumatic in itself in the way it was performed, and in subsequent complications. Other women have stories much worse than mine, indicating clear instances of abuse and bad practice, sometimes bad outcomes as well.

We have a multitude of evidence indicating that unnecessary c/sections are both common and rising to epidemic proportions, with troubling implications for maternal and fetal mortality in this country.  We have a member of the obstetric community on record as stating they were not convinced that a woman in labor was a full person with the right to determine her own medical treatments, an attitude tantamount to declaring women less than human, at least while they are pregnant.

These are injustices that need addressing, not by achieving happy VBACs, but by demanding institutional reform.  You cannot reduce domestic violence simply by giving women relationship advice or access to a divorce lawyer, good as those things are. You also have to enforce the laws against it. You also have to educate children in a way that makes it less likely for them to become abusers. You also have to change public attitudes away from being accepting of abuse. 

Injustices in how women are treated during birth are no different.  You have to assert and defend women’s rights to determine their own care, and to refuse it, even when pregnant. You have to educate doctors and medical staff about those rights, and about the proper way to treat laboring women in their care respectfully.  You have to change public attitudes about birth, away from a painful and dangerous experience always requiring medical experts to a natural event that is, most of the time, achievable and safe for most women if they are treated respectfully and given a minimum amount of assistance.

The medical mistreatment of women highlighted by the skyrocketing c/section rate is not just a string of isolated personal tragedies; it is a big deal. If you want to provide support to women you know who are dealing with a traumatic or coerced c/section, the best thing you can do is to recognize and understand what they were up against.

VBAC Scare Tactics: Big Baby, Big Problem

Great article from: http://birthingbeautifulideas.com/?p=905

 

Many women who want to have a vaginal birth after cesarean (or VBAC, pronounced “vee-back”) in the U.S. and elsewhere have faced some sort of opposition from their care providers when they have expressed their desire to VBAC.  Oftentimes, this opposition comes in the form of ” VBAC scare tactics.”

The (outrageous) statements are often misleading, exaggerated efforts by OBs (and yes, even midwives) to discourage women from VBAC and to encourage them to “choose” a repeat cesarean.  (Of course, it’s not really a choice if your provider won’t even “let” you VBAC, is it?)

If you find yourself up against a barrage of scare tactics–as I once did–it can be exceedingly difficult to stake your claim and argue against the doctor (again, or midwife) who may or may not have your and your baby’s health prioritized higher than medico-legal concerns and who may or may not be insinuating that VBACs are synonymous with driving your child in a car without a car seat.

If you do find yourself facing such scare tactics, and if you do want to have a VBAC, there are some questions that your care provider should be able to answer when s/he hurls those scary and/or outrageous comments and standards your way.  And if s/he refuses to or even cannot answer these questions, then you might want to consider finding an alternative care provider–one who is making medical decisions based on research, evidence, and even respect for your patient autonomy and not on fear, willful ignorance, or even convenience.

I encourage all mothers who read this post (and others in my “VBAC Scare Tactics Series”) to  take the information contained herein as a springboard from which they can 1) continue their research on VBAC, 2) maintain a communicative relationship with their care providers, and 3) find a care provider who best supports the mother’s interests and plans for the birth of her child.

(To read my disclaimers about “why I am not anti-OB” and “why I take the gravity of uterine rupture seriously,” please see my posts on VBAC scare tactics (1) and (2) .)

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Scare tactic #10: Based on this recent sonogram, your baby is getting way too big for a vaginal birth, especially a VBAC.  You can’t safely have a VBAC with a macrosomic baby.  We’re going to need to schedule a repeat cesarean as soon as possible.

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Questions to ask your care provider:

  • How accurate are sonograms at predicting fetal size, particularly at the end of a pregnancy?
  • What special concerns do you have when it comes to a woman birthing a “big baby”?
  • Does fetal macrosomia increase the risk of uterine rupture?
  • What does ACOG recommend when it comes to fetal macrosomia and VBAC?

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A more nuanced analysis:

When a physician or midwife uses terms like “suspected fetal macrosomia” or “LGA” or “large for gestational age” in reference to your baby, what s/he means is that your baby’s estimated weight has exceeded a particular cut-off point: typically, either 4000 g (or 8 lbs. 13 oz) or 4500 g (or 9 lbs. 15 oz).

The reasons for denying women the opportunity to plan a VBAC with a suspected macrosomic baby may vary.  Some care providers might think that this increases the risk of uterine rupture.  Others might want to forego the slightly increased risks associated with fetal macrosomia.  And many might regularly schedule cesarean sections for all suspected macrosomic babies, whether or not their mothers have scarred uteri.

And, to be fair, there are some increased risks associated with fetal macrosomia, particularly if women have diabetes or uncontrolled gestational diabetes/gestational diabetes mellitus/GDM.

For one, fetal macrosomia is associated with a greater risk of shoulder dystocia, a labor complication that is serious but nearly impossible to predict, especially before labor even begins.  (Notably, the overall risk of shoulder dystocia during labor is approximately .6-1.4%.  What’s more, approximately one-half of all cases of shoulder dystocia occur with infants who weigh less than 4000 g–that is, who are not macrosomic.  )

Fetal macrosomia is also associated with a greater risk of cesarean section, although this is likely related (among other things) to the relative immobility with which most women labor in hospitals, to the rising rates of labor induction, and to the fact that many care providers recommend prophylactic cesarean section for suspected fetal macrosomia.  (Worth noting is that labor induction–which does slightly increase the risk of uterine rupture–has not been found improve labor outcomes for women and babies where the fetus is suspected to be large.)

Nonetheless, barring any pregnancy complications that would greatly increase these and other risks associated with fetal macrosomia, the absolute risks themselves are quite low, and certainly not high enough to bar all women carrying fetuses who are suspected to be macrosomic from delivering those babies vaginally.

In this respect, it is exceedingly important to remember that any suspicions about fetal macrosomia are just that–suspicions, estimates, educated guesses.  In fact, weight estimates gleaned via ultrasound can be “off” by as much as one to two pounds!  So even if ultrasound measurements determine that your baby is measuring 10 pounds, you might actually have an average-sized 8 lb. baby (or, to be fair, a larger-than-average 12 lb. baby).  Thus, it is worth asking your care provider why this estimate by itself would disqualify you from planning a VBAC.

To this effect, your care provider might state that fetal macrosomia lowers the likelihood of a successful VBAC and that it increases the risk of uterine rupture.  S/he might even mention the most current ACOG Practice Bulletin on VBAC, which does refer to some “limited evidence” showing a higher risk of uterine rupture associated with “women undergoing TOLAC [a trial of labor after cesarean] without a prior vaginal delivery and neonatal birth weights greater than 4,000 g.”

But this very excerpt from the ACOG Bulletin demonstrates that the issue is more complicated than simply claiming that “fetal macrosomia increases the risks of uterine rupture.”  For instance, while there is evidence suggesting that higher birth weights are associated with higher rates of uterine rupture, ACOG itself acknowledges that this evidence is limited.  (The study I’ve linked to here examined 2586 women, but only 269 had babies with birth weights greater than 4000 g.  This is a fairly small population, especially when one is considering using the study to disqualify women with suspected large babies from planning a VBAC.)

What’s more, although a large baby may lower one’s chance of having a successful VBAC, this does not mean that one has an absolutely low chance of having a VBAC with a large baby.  In fact, in the aforementioned study, the VBAC success rate among women who birthed babies weighing over 4000 g was 62%–not exactly a low success rate!  (And to be clear, the other 38% were simply those women who had cesarean sections following their VBAC attempts–not necessarily those who had uterine ruptures following their VBAC attempts.)

Finally, the current ACOG Practice Bulletin on VBAC also mentions the fact that most (if not all) of the studies examining VBAC success rates, uterine rupture rates, and fetal macrosomia used “actual birth weight as opposed to estimated fetal weight thus limiting the applicability of these data when making decisions regarding mode of delivery antenatally.”  In other words, the data used in these studies pertained to babies who were actually macrosomic–not babies who were suspected to be macrosomic.  It pertained to actual birth weights–not to weight estimates.  Thus, particularly since fetal weight estimates are notoriously inaccurate, it is questionable whether or not one can or even should apply these studies to any sort of prenatal counseling–especially counseling that dictates whether a woman should deliver her baby vaginally or via cesarean section.

In this respect, it is important to take note of ACOG’s most recent recommendation on VBAC with suspected fetal macrosomia:

it remains appropriate for health care providers and patients to consider past and predicted birth weights when making decisions regarding TOLAC, but suspected macrosomia alone should not preclude the possibility of TOLAC.

So if your care provider is denying you the opportunity to have a VBAC based only on suspected fetal macrosomia, you should definitely consider asking why s/he is departing from ACOG recommendations in this matter and/or what other reasons s/he has for barring you from a VBAC.  (You might also consider finding a more supportive care provider! 

Or just refuse an unnecessary cesarean, as it is your right to do!)

What’s more, you can always maximize your chances of a successful VBAC with a suspected large baby by walking, moving, and changing positions during labor and by avoiding giving birth on your back.  The more you move and remain upright, the more you take advantage of gravity and of your pelvic flexibility and mobility to help bring your baby into the world.

And suspicions about a large baby should not preclude you from doing just that.

Gestational Diabetes Lowers VBAC Odds

This article is from: http://findarticles.com/p/articles/mi_m0CYD/is_12_37/ai_87776271/

Thankfully I still have a good chance of getting my VBAC.

LOS ANGELES — Women attempting a vaginal birth after a previous cesarean delivery are more likely to need another C-section if they have gestational diabetes, but their chances of a successful vaginal birth are still good, Dr. Dominic Marchiano said.

Vaginal birth after a prior cesarean section (VBAC) succeeded in 68% of women with gestational diabetes and in 75% of women without gestational diabetes in a retrospective study of 25,079 pregnant women with a history of C-section. The study participants were seen at 16 community and university hospitals in a 4-year period, Dr. Marchiano reported during the annual meeting of the American College of Obstetricians and Gynecologists.

Stated another way, women with gestational diabetes were 23% less likely to have a successful VBAC.

The 6% of women who had gestational diabetes were less likely to attempt a trial of labor after a previous C-section: Only 40% of the 1,465 women with gestational diabetes attempted VBAC, compared with 54% of the 23,614 women without the disorder, said Dr. Marchiano of the University of Pennsylvania, Philadelphia.

The results of the study may have been affected by factors in the preselection of patients attempting VBAC such as prior pregnancy history, estimated fetal weight, or physician and patient preferences, he acknowledged.

Other limitations to the study include the inability to control for factors involved in the induction of labor, Dr. Marchiano said. Investigators also had no information about physicians’ thresholds for halting a trial of labor already in progress to perform a C-section.

For the patients who attempted VBAC, the investigators controlled for confounding variables including birth weight, maternal age, tobacco use, chronic hypertension, and pregestational diabetes. More women in the gestational diabetes group had chronic hypertension. Differences between groups in gravidity, maternal age, and gestational age were statistically different but not clinically significant.

Birth weights were similar between groups, “so our finding of different success rates in patients with or without gestational diabetes is not attributable to higher birth weights among the diabetics,” he said.

Gestational diabetes occurs in 2%-5% of pregnancies and is associated with macrosomia and increased use of C-section. ACOG does not recommend doing a C-section based simply on the presence of gestational diabetes.

The only previous study to examine the combination of VBAC and gestational diabetes included fewer women seen at a single institution.

Investigators in that study also concluded that, although the likelihood of C-section is slightly elevated in women with gestational diabetes, VBAC remains an acceptable alternative in this population (Am. J. Obstet. Gynecol. 184[6]:1104-07, 2001).

Compared to this earlier study, “ours is a larger and more diverse patient population. We believe our data are applicable to most practice scenarios,” he said.

Physicians should counsel women with gestational diabetes that they have a slightly higher risk of VBAC failing but that “the overall success rate is still favorable,” Dr. Marchiano said.

I want a VBAC: What are my chances?

This is also taken from a babycenter.com article. It’s very encouraging to those of us who are dreaming about having a VBAC. Read:

What are my chances of giving birth vaginally after having a c-section?

As long as you’re an appropriate candidate for a vaginal birth after a cesarean, also known as a VBAC, there’s a good chance you’ll succeed. Of course, your chances of success are higher if the reason for your prior c-section isn’t likely to be an issue this time around.

For example, a woman who has already had an easy vaginal delivery and then had a c-section when her next baby was breech is much more likely to have a successful VBAC than one who had a c-section after being fully dilated and pushing for three hours with her first baby who was small and properly positioned. (Having given birth vaginally boosts your odds dramatically.)

That said, it’s impossible to predict with any certainty which women will achieve a vaginal delivery and which will end up with a repeat c-section. Overall, about 60 to 80 percent of women who attempt a VBAC deliver vaginally.

If you decide to try it, you’ll need a caregiver who supports the idea. Your caregiver must also have admitting privileges at a hospital that allows VBACs and where appropriate coverage is available around-the-clock.

An increasing number of hospitals have strict criteria regarding who will be allowed to attempt a VBAC because of controversy about their safety, specifically the potential for uterine rupture — a rare injury, but one that can be catastrophic for mother and baby.

What are the benefits of having a VBAC?

I found a good article on Babycenter.com and I wanted to post a few excerpts here on my blog. I’ve had several people ask me (in various ways) “Why don’t you just have a repeat c-section?” This is the answer to that question. Basically the benefits (for mom AND baby) outweigh the risks. Read this short article:

A successful VBAC allows you to avoid major abdominal surgery and the risks associated with it — including a higher risk of excessive bleeding, which can lead to a blood transfusion or even a hysterectomy in rare cases, as well as a higher risk of developing certain infections. A c-section requires a longer hospital stay than a vaginal birth, and your recovery is generally slower and more uncomfortable.

If you plan to have more children, you should know that every c-section you have increases your risk in future pregnancies of placenta previa and placenta accreta, in which the placenta implants too deeply and doesn’t separate properly at delivery. These conditions can result in life-threatening bleeding and hysterectomy. And a recent large study found that the risk of some other delivery complications also rises with each c-section.

Finally, if you were disappointed about having a previous c-section, you may feel a tremendous sense of pride and accomplishment at being able to deliver vaginally this time around.

A Woman’s VBAC Journey

I wanted to share with you someone else’s experience. It is very enlightening! The following is written by Pamela Candelaria who writes over at Natural Birth for Normal Women. 
I’m going to come right out and say it: The single biggest reason I wanted a VBAC was because I wanted the experience, magic-filled and complete with angelic music and ethereal light. Well, yes, I had romanticized it a bit, but I had a very clear vision of my ideal birth before my firstborn was a twinkle in his daddy’s eye.  I believe giving birth is a rite of passage, and the actual physical act of giving birth is the highest expression of feminine power.  I was shocked when I ended up having a c-section to deliver my first baby, and it was an enormous struggle for me to work through my feelings of failure. There was never a question that I would pursue VBAC when I had more children. Or at least, there was never a question until I got pregnant again. 
Then it started. I knew I had to be better informed this time, make better choices to have a better birth. My starting point for research was the internet, and it was absolutely filled with horror stories about VBACs gone wrong, catastrophic uterine ruptures that killed babies and left mothers hemorrhaging and facing hysterectomy. If only they’d chosen another c-section, their babies would be alive and they would be able to have more children. My conviction began to falter. I kept reading. I read the derision heaped on VBAC moms, the accusations that we were trying to get a “vag badge” or would rather have a vaginal birth than a healthy baby. I wondered if I was putting my own desire for an experience above the health of my baby. If that was the case, I needed to re-evaluate my priorities make peace with having c-sections for all my children.  
In the midst of my searching, something wonderful happened. I found an online support group full of women who not only knew absolutely everything about VBAC and repeat cesarean (RCS), but were able to direct me to the sources so I could learn it myself. I started reading studies- actual studies that looked at thousands of births. I could see the biases and flaws in the research, and I was able to critically evaluate how the conclusions of the studies were affected by those biases. I had support, I had encouragement, and I had resources- and this is what I learned:
VBAC is safe. Let me say that again: VBAC is safe. That is not to say it is without risk, but any pregnancy following a c-section carries greater risk than a pregnancy with an unscarred uterus. On the whole, VBAC provides better outcomes for mothers and babies than scheduled repeat cesarean.  VBAC babies have higher APGAR scores, lower rates of NICU admission, less need for supplemental oxygen, and shorter hospital stays than babies born by RCS. VBAC moms have less time in the hospital, too, and they also enjoy significantly lower rates of infection, hemorrhage, transfusion and hysterectomy. Repeat cesareans are 2-4 times more likely to result in maternal death than VBAC, but death related to uterine rupture in a VBAC attempt is unheard of. Because I wanted a large family, it was critical for me to learn that risks in future pregnancies dramatically decrease with multiple VBACs, but dramatically increase with multiple c-sections. Having this information renewed my confidence in my decision to VBAC, but it left me with questions, too. Why was the obstetric world so against VBAC? And why do only 10% of women choose VBAC? 
The answers to those questions are multifaceted. The factors influencing modern obstetric care in general, and VBAC specifically, are complex and interwoven to the extent that it’s nearly impossible to separate them. Medical malpractice suits are a huge part of the equation, and there are lawyers ready and waiting to vilify OBs who support VBACs. It’s estimated that 30% of OBs have stopped supporting VBACs solely because they fear malpractice liability, and another 29% have increased their c-section rate for the same reason. The ACOG issued guidelines requiring “immediate” availability of emergency c-section for VBAC moms, and as a result nearly 1/3 of hospitals stopped supporting VBAC labors. But with the majority of OBs and hospitals still allowing VBAC, I wondered, why do women choose RCS in droves? 
It is common (though inaccurate) knowledge that VBAC is safer for mothers and RCS is safer for babies, and there is a strong social expectation that we as mothers should be willing to sacrifice our own safety to ensure the safety of our babies. We fear we’ll be held responsible if a VBAC goes wrong, but choosing RCS makes the OB responsible for the safety of the baby during birth. Many OBs provide misleading information about the risks of VBAC, guiding women to “choose” RCS because it is falsely presented as risk-free.  Other OBs claim to be VBAC-supportive, but have a laundry list of criteria that virtually guarantee no one will ever achieve a trial of labor. VBAC is no longer a mainstream birth choice, and when faced with unsupportive providers, misinformation, scare tactics, and a constant need to be vigilant and advocate for ourselves to ensure we’re given an opportunity to birth the way we want- well, is it any surprise that most of us opt out? 
After all my hours of research, I felt vindicated. Not only was my desire for a birth experience okay, but going ahead and having that experience was going to be better for me and my baby and all my future babies too. I was also lucky; my OBs never questioned my decision to VBAC and they were supportive and encouraging throughout my pregnancies. I have now had three VBACs, and oddly enough, there wasn’t a single one marked by angelic music or ethereal light. I never had that ideal birth I’d envisioned. It was just me, birthing my babies, having that experience, doing a little part of God’s work. And I wouldn’t trade it for the world.  

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