Scars remind us where we've been. They don't have to dictate where we're going

Tuesday, April 12, 2011

VBAC is a whole nother ballgame

In a lot of VBACtivist literature and online forums, I often see women campaigning for VBAC to be called something along the lines of "normal birth" or "natural birth" after cesarean.  I understand why--for me, and a lot of other women, planning vaginal births after one or more cesareans is the norm, and categorizing what we are doing as "normal" or "expected" would do a lot towards shifting attitudes about VBAC safety.  But I think it's also important that we don't lose sight of the reality of the matter, even while we try to change things.  The truth is VBAC is a whole other animal than a vaginal birth in a first time mother or a mother who has no previous cesareans.  And I think it is imperative to educate VBAC hopeful mothers about things that could make a difference between having a successful VBAC (or a chance at one) or a RCS.

I met a new mom friend at the park who is pregnant with her second baby and would like to try for a VBAC.  She loves her OB--although she had pitocin, etc. during her labor, he didn't pressure her to induce around her due date, and he was going to "let" her try to push "even after" she had been "stuck" at 9 cm for a couple hours (oh man, there are a lot of quotes in that one....but you know why they're there).  Of course, we got all birthy and talked about her hopes for this birth--after our first meeting, I sent her an email about her options as a VBAC mom, of course trying to not be too biased towards home birth, but I totally gave her my midwives' names and websites.  I can't help myself.

In subsequent discussions, I have tried to gently broach topics that would be important to a VBAC mom--how far postdates her doctor is comfortable with her going, making sure she has an accurate guess date,  his induction policy for VBACs, etc.  Of course, loving her OB, and based only off her experience with him as a primapara with an unscarred uterus, she tells me how great he is about not pressuring her to induce early and how she's sure of her dates, etc.  But the truth is, it is a whole different world when you are a VBAC mom, particularly in Austin.  She has an 8 week appointment coming up, when she knows when they conceived and will actually only be 7 weeks.  It is so hard for me, in situations like this, to not scream at the top of my lungs to make sure her guess date is accurate in the records.  A week can make a world of difference for a VBAC mom in terms of pressure to induce if you haven't gone into labor by a certain date.  And if your guess date is off by a week, and you are either induced or RCS on an arbitrary date based off an inaccurate date, that is a week of crucial lung development time baby needs, not to mention the risks of inducing to a VBAC mom.

I think it would be great if we could normalize VBAC more.  It should be the case, absent other risk factors that would preclude a vaginal birth, that a mother with a previous cesarean have the best chance at a VBAC.  It is safer, statistically speaking, for both mother and baby.  But until that's the case--and care providers treat VBAC as such, without overly restrictive limitations that would compromise a VBAC that might otherwise be successful--we must educate women about what to expect from their care providers.  It is simply not the case, in many areas, that a VBAC mom will be able to expect the same treatment from her care provider as she would if she didn't have a scar on her uterus.  And maybe, just maybe, if we arm VBAC moms with all the resources and information they need to have their best birth, we would see more VBAC hopefuls become VBAC successes--that would really go a long way in the "normal birth after cesarean" movement.

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