Workshop Wrap-Up: VBAC and Cesarean Birth
CIC’s Healthy Birth Choices Workshops on Vaginal Birth After Cesarean (VBAC) and Cesarean Birth are often particularly personal and powerful. Every expectant or prospective mom in the audience has either faced or is facing a birth which did not go the way she had hoped. All are seeking support, information and resolution as they prepare for their next baby’s birth.
Those who came to our most recent meeting brought with them many questions, all closely focused on the logistics involved in a successful VBAC. Is there a correlation between epidurals or induction and cesarean sections? How can I increase my likelihood of success if I am induced? Which special hospital protocols may apply for VBAC and are they necessary? These were addressed by home birth midwife Joan Bryson CNM and family physician Dr Marc Levin, who kindly joined us to answer questions and provide a care provider’s perspective on the VBAC. Our three mom speakers all shared powerful stories of difficult decisions during their pregnancies and births, and their journeys to find peace with and take ownership of their birth experience.
Dani planned for a natural birth with her first baby, even switching care provider from her regular OBGYN (wary of her hospital’s high cesarean section rate) to one who attended births at a hospital-based birth center. In labor, she said, “everything seemed to be going smoothly – then things slowed down.” Discouraged by her OB’s negative comments about her ability to birth naturally and the pressure for interventions, after 30 hours of labor she agreed to pitocin and an epidural. The epidural, however, did not take properly and she was left feeling severe nerve pain but unable to feel her baby descending as she pushed. Her baby moved down, then back up several times until the decision was made to have a cesarean section. It turned out her daughter had been tangled in her short cord.
Despite being told that the surgery was necessary, Dani was deeply affected by her birth experience and her physically and emotionally traumatic experience of cesarean section after a long labor. When she found she was pregnant again, she was open to having a planned cesarean section in order to avoid this. At the same time, though, she wanted to try again for a natural birth. “I needed to feel I had the full experience and like I finally had control,” she told us.
Dani returned to her original OB, and was surprised to find her very supportive and encouraging of her plans for VBAC. In contrast with her first experience, her OB continued to encourage her throughout her labor, telling her how well she was handling it and that there was no reason she could not give birth the way she wanted to. While she had to have continuous monitoring, she was able to be out of bed and, most importantly for her, to be on her birth ball. “Which is all I really wanted.”
This time, with her husband’s and OB’s encouragement, Dani had the birth experience she wanted. “There is something extraordinary about having the agency and the support to make this happen, because you aren’t just this body laying there being manipulated,” she told us. Her son’s birth, she said, “is truly the one thing that was able to erase the trauma of the first birth.”
When Marjorie-Helene was pregnant with her first baby, she planned to give birth in a free-standing birth center. In the week leading up to her Estimated Due Date (EDD), she experienced major stressful crises – a flooded basement, a death in the family and hosting family visitors among them. Perhaps unsurprisingly, the midwife at her prenatal checkup found her blood pressure was elevated. She was sent to the hospital for an induction, which failed. Her body was just not ready. Fortunately, her regular midwife allowed her to return home.
Over the next couple of weeks she experienced more stress as well as impatience from some family members about having passed her due date and whether this would put her baby in danger. Nervous about this pressure, she tried various methods to get her labor started, with no luck. “My babies like to come late,” she told us. “And I didn’t know that.” In the midst of this stress, at her 41 week prenatal appointment her blood pressure was again elevated and again she was sent to hospital for induction. After two days of working to get her labor going on the birth ball, on pitocin and a full 24 hours of magnesium sulfate for suspected pre-eclampsia (later found to be unnecessary), she was exhausted. “I was just done fighting,” she told us. Her son was born by cesarean section.
After this experience, which was followed by difficult postpartum care, Marjorie-Helene knew she never wanted to give birth in hospital again. After much research, with her second pregnancy she decided to hire a home birth midwife and was lucky enough to find one who accepted VBAC clients. She told her midwife: “’I just know this is going to be a 43 week baby.’ She said, ‘okay.’” In the event, her daughter arrived at 42 weeks and 5 days, after a couple of weeks of on again, off again contractions and an intense, 60 hour labor. “For 30 hours of that I was just cleaning my house!” Part way through, as her contractions were 90 seconds apart, her son woke up, screaming “no!” And suddenly labor stopped. Her son went to a friend’s house and labor eventually resumed. Her daughter was born just before 6am. “It is a really great feeling to just be able to have that birth,” she said.
Marjorie-Helene’s third birth was a marked contrast to the previous two. After a week of early labor, her water broke – something she had not experienced with her other babies. She felt intense contractions and headed into the shower, already pushing her son out by the time her midwife arrived. In just a few hours, she had had another beautiful, successful VBAC.
Sarah planned to have her baby with a midwife at a hospital-based birth center. A yoga teacher, she had spent the morning following her baby shower watching the movie Orgasmic Birth with her friends and had her heart set on a natural birth. Late in her pregnancy, she learned that her baby was in a breech (head up) position. She tried everything she knew to encourage her baby to turn: “acupuncture, chiropractic, headphones, ice – every single thing that you’ve ever heard, I did it!” But nothing was working. On her midwife’s suggestion, she scheduled an External Cephalic Version (ECV). However, her gut feeling was that this was not right for her.
“I was really having such a challenge with it,” she told us. She called friends and family to talk it through, knowing she was afraid of cesarean section. Her midwife told her that they used to deliver breech babies vaginally for years, but that now, with malpractice issues, they couldn’t do it any more. Still, the idea of version didn’t feel right to Sarah. She decided to meditate and to listen to her baby’s wisdom about what to do. “It was crystal clear,” she said. “Don’t move me”.
Believing that things happen for a reason, Sarah scheduled a cesarean section. “I wasn’t running this show,” she noted. “As much as I wanted to control it, I couldn’t control it.” On the day, she meditated all morning and went into hospital feeling relaxed and calm. Her doctor “was phenomenal – he knew I wanted a natural birth.” Her friend, a nurse at the same hospital, was in the OR with her. They played music and mantras of her choice and lowered the lights according to her wishes. She even got to keep part of her placenta. Her baby’s arrival by cesarean felt “bizarre” but still magical. “He lifted her over the curtain and put her right on my face. She was so alert! Everyone said she was the most alert cesarean baby they had ever seen.”
Sarah later learned that her daughter’s cord had been wrapped around her neck such that she could not have been born another way. “The biggest lesson I learned was to always trust my intuition,’ she said. “Because the minute I heard the word ‘version’ I had such a strong reaction – I thought, ‘no way.’”
s and preferences, both for VBAC and for cesarean section, is one important way in which we can begin to work towards this. This dialogue and preparation were important to Dani: “Even if I’d had another cesarean section, I think I’d set it up so that I had choices.”
“The most important decision you will make is choosing your care provider,” Joan Bryson stressed. “If you have the right provider, that’s what matters. It doesn’t matter if you have a crappy room.” She encourages expectant parents to ask pressing questions and listen carefully to the answers. “Trust is a two way street.” For Dani, going back to her first OB was crucial in the success of her VBAC and how she felt about it. “I felt so protected by her, she really listened to what I had to say. Knowing that you feel safe with that person, it makes all the difference in the world.”