This got a little heated for awhile, and sent to a couple groups to be bashed (haters gonna hate). I’m just going to put the disclaimer at the top now…
DISCLAIMER: I am not a medical professional. These facts are taken from studies, research and experience, but you should definitely consider a trusted medical professional before a blog post. My intent is to inform and encourage advocacy!
I also removed the post for a day so I could regroup and reword some of the things I meant to say. So here goes.
I am NOT anti-doctor. I have a wonderful OB, a great pediatrician, and if I feel the need to see a doctor or something, I will. I’m not anti-doctor, but I am pro-informed decisions. Especially when it comes to birth. You need to take the bull by the horns and do your research, ask questions of your providers about every single procedures, trust your intuition, and make decisions. Because sometimes, sometimes, your provider is not as supportive as you think they are. Lord knows I hear it every single day. “My doctor did this, my doctor wants this, but I don’t… can I say no?”
Yes. Yes you can say no. Even if the studies and evidence have shown otherwise. You are in control of your body and you decide what seems safe to you.
So there. I re-worded some things below, to better get my point across. This post is meant to get you started on your research, and not the be-all-end-all of your decision making. Goodness, please don’t let it be.
And you know? I’m also I am pro-whatever decision you want to make once you do the research. If that means you want a VBAC, then go for it. If you decide to have a repeat cesarean, good on you! If you want to go with a hospital birth, home birth, unassisted, birth in a field… that’s your choice. That’s the beauty of birth, there are lots of choices. Just make an informed one. What’s good for me might not be good for you.
Having had a cesarean birth with the hopes of achieving a VBAC (vaginal birth after cesarean) in a couple short months, VBAC moms are especially close to my heart. I hear and see their struggles every day all over the web — mothers fighting with emotions over previous birth experiences, mothers filled with hope for the future, mothers unsure of whether they would prefer to schedule another cesarean or go for that vaginal birth, and mothers facing opposition from care providers and family alike.
I think VBAC moms are in an especially tough situation when it comes to future births following their cesareans. The decision on how they would like to birth does not come easy anymore. It’s not as simple as choosing a vaginal birth and that’s that. These women, myself included, are met with an information overload as they try to decide what’s best for them and their babies.
Nothing bothers me more than misinformation; I see mothers on boards and blogs wondering what to do if their doctor says such-and-such. Do they have to agree with this or that procedure? What if their doctor just says no? My doctor told me I had to do this… do I actually have to?
So let’s talk about some of the things you might here from your doctor, and why they are false.
Once a cesarean, always a cesarean.
Let’s start with the biggest myth — just because you had a previous cesarean, or two, or more, does not mean you will have to have one with your future births. This is an antiquated myth (coming from a time when cesareans were vertical incisions, which can be dangerous in future births) that seems to persist with a lot of women, though most doctor’s will agree that it isn’t true. However, you’ll still meet some providers who deliver the “bad news.” Sorry, you’ve had a cesarean, so we need to do another. If you don’t know any better, than you might just agree. Of course, it’s your choice whether you want to have a repeat cesarean or not. If you want that VBAC, though, be aware you have the option. Even if you’ve had two or more previous cesareans.
“In August 2010, the College issued a new Practice Bulletin, Vaginal Birth After Previous Cesarean Delivery, that states that attempting a VBAC is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans.” (source)
It’s just safer this way. Your uterus could rupture.
The mother is the one who should be determining the safety of her birth. Once she is given the information she needs, she should be able to make an informed decision on how to move forward.
Let’s talk about uterine rupture, though, and other risks involved with a VBAC or a repeat cesarean. You might hear a lot about VBAC risks without hearing much about what happens if you have multiple cesareans. Uterine rupture can occur in women who haven’t even given birth yet, during or before labor. The chance of uterine rupture with a first VBAC is less than 1%. With future VBACs, that risk goes down. However, with each cesarean, you run a higher risk of hysterectomy, blood transfusion, hemorrhage, major adhesions (where scar tissue attaches to places in your abdomen), placenta accreta (where the placenta grows through the uterine wall and attaches to other organs; can be life-threatening), and even death. Yes, women die during cesareans, much more than women die during vaginal births.
There is no way to tell if your uterus will rupture. Understand, too, that there are degrees to ruptures. A small percentage of ruptures is catastrophic, while most are small “windows” that pop up in the scar and are only noticed when a repeat cesarean is called for.
We can’t do VBACs here because we don’t have the facilities to handle an emergency.
Then why are you even going to that facility? A VBAC birth is no different than a normal vaginal birth. A vaginal birth can go terribly wrong as well and require an emergency cesarean, do they not have facilities for that? Every hospital that allows birth, any birth, needs to be equipped to deal with emergencies. Simple as that.
Your babies are too close together.
The recommended time between births is somewhere between 18 and 24 months. Some studies even show you should be waiting three years between births. However, as we all know, babies come when they came. What if your next baby is due 12 or 15 months after your cesarean? Do you have to have another cesarean? The short answer is… no. The long answer is… this is a decision you have to make yourself. There are more risks involved with having children closer in age, even with vaginal births, but especially with cesareans because your body does need time to heal. Find a trusted care provider and discuss it at length.
You must give birth by 41 weeks.
Straight from the ACOG (American College of Gynecologists): “Studies evaluating the association of gestational age with VBAC outcomes have consistently demonstrated decreased VBAC rates in women who undertake TOLAC beyond 40 weeks of gestation. Although one study has shown an increased risk of uterine rupture beyond 40 weeks of gestation (76), other studies, including the largest study that has evaluated this factor, have not found this association (77). Although chances of success may be lower in more advanced gestations, gestational age of greater than 40 weeks alone should not preclude TOLAC.”
**TOLAC = trial of labor after cesarean
You are not a machine. Tell yourself this over and over. You are not a machine. You do not have a timer set on your uterus that goes off on your estimated due date. Your baby isn’t watching a calendar. Many women have successful VBACs are 41, 42, even 43 weeks.
Understand that normal gestation is anywhere from 37 to 42 weeks. Also understand that due dates are estimates, they cannot be completely trusted, and even if you know the exact date you conceived, it doesn’t mean that the baby is ready at 40 weeks. Every baby is different. Every mother is different. This is a decision you have to make for yourself, of course, and what your comfort level is in birth.
Your baby is just too big to fit (*prior to a trial of labor).
Late-pregnancy ultrasounds have been proven to be inaccurate. Say your care provider does an ultrasound at 37 weeks and estimates the baby to be 8lbs, and whoa, this could mean your baby could be 11lbs or more! Or they measure the baby’s head and see, wow, that just won’t fit, it’s so big. Or worse, they don’t even measure, and because your previous baby was larger, you will most likely have another large baby and well, too bad, time for a cesarean at 39 weeks.
Late-pregnancy ultrasounds can be off by several pounds. It isn’t unusual to hear of a mother agreeing to a cesarean for her suspected large baby, who happens to come out weighing 7 or 8 pounds, or with a normal sized head.
But even if the baby is large, even if the baby has a larger-than-normal head, does not preclude you from achieving a VBAC. You have no idea what your body is capable of doing. The pelvis can move and shift in incredible ways, accommodating babies of all sorts of sizes. In most women, your body will not make a baby you cannot birth. Look at your family history of baby sizes — notice something? You will usually have a baby that’s a similar size to what your mother and other women related to you have had. (Not researched, just anecdotal from my days of being a doula.)
In any case, you won’t know if you can birth that baby until you try. This also means that when in labor, you need to be up, shifting your hips, squatting, whatever. Not lying flat on your back with an epidural. Birth takes work.
You haven’t dilated yet, so you probably won’t go into labor by 40 weeks.
There is no reason to have cervical checks before you’re in labor, and even then, it’s your body and your choice. Anyway, sometimes providers will want to check your dilation as early as 37 weeks, “just to see what’s happening.” So you get checked and the provider finds you at 1cm, if that, and they might say, “You aren’t dilating yet, you might never go into labor, let’s just schedule a cesarean.”
I want you to know your body is not broken and it is not a machine. Your cervix is meant to keep the baby in until it’s time for the baby to come out. I have seen women go from closed up tight in the morning to a baby in their arms that evening. I have also seen women be at 3cm dilated for weeks and give birth at 42 weeks. Early cervical dilation is not an indication of your ability to go into labor or when you’ll even go into labor. Let your body do its thing.
You must have an epidural, just in case.
Just in case of what? An emergency? Understand that if you need a cesarean under true emergency situations, you will probably be given general anesthesia even if you have an epidural in place. A normal epidural during labor is not as strong as one needed for a cesarean, and during an emergency they would not have time to increase the dosage because they would just need to get the baby out. Some providers would like you to have an epidural catheter in place with no medication, but again, it’s the same situation: In a true emergency, you won’t have time. If you have time to discuss your cesarean, to wait for X amount of time, you have time to continue to labor.
You need to have continuous or internal monitoring, just in case.
As the laboring woman, you have the right to consent to any procedure, including continuous or internal monitoring. While the ACOG supports continuous monitoring, it does not outright suggest internal monitoring (“Most authorities recommend continuous electronic fetal monitoring. No data suggest that intrauterine pressure catheters or fetal scalp electrodes are superior to external forms of monitoring, and there is evidence that the use of intrauterine pressure catheters does not assist in the diagnosis of uterine rupture.”) Continuous monitoring won’t necessarily prevent a rupture, but it could help diagnose it earlier.
An option you can discuss is to have intermittent monitoring, if possible, for 20 minutes every hour. And if the provider insists on continuous external monitoring, be sure to ask about the equipment (Can you use it in the bath? Can you move around easily with it? Will I be stuck on the bed?) and determine if you’re comfortable with the answers. Many women are able to labor with continuous monitoring beside the machine, either on the ball or kneeling on the bed. Know you don’t have to lie there motionless, and you don’t have to have an epidural if that’s your choice!
**I’ve gotten a few comments about this. Yes, the ACOG recommendation is to have continuous monitoring, and if that is what you’re comfortable with, then go with it. You need to review all the facts, studies, and your own intuition, and of course talk to your provider, and follow the course that fits you. I know for me, it is intermittent monitoring. For others, it’s continuous. Be confident in your choices and refuse to be bullied.**
I calculated your VBAC success rate and it’s looking low — you probably won’t be able to achieve a VBAC.
Yes, there is a VBAC success calculator. Again, you’re not a machine, why rely on percentages? You do not know if you will get your VBAC unless you try.
Let’s just schedule a cesarean. It’s better for both our schedules.
Babies aren’t good for schedules, as you might know if you’ve already had one or more. Why put yourself through major surgery to accommodate a schedule? Whether that be yours, your husband’s, your care provider’s, your mom’s, etc. Babies will come when they come, and yes, it can suck sometimes, but that’s part of the package, right?
This post is not meant to offend anyone, I’m just simply trying to get some of the misconceptions out for the world to see. If you WANT a VBAC, and you’re healthy, your baby is healthy, and there is no reason you can’t, then by all means, GO FOR A VBAC. You will only give birth to that child once, ever, so make it as informed and memorable as possible.