I, Roberta, mistress of my domain, will, in just a few short months, be attempting to have a successful Vaginal Birth After Cesarean (VBAC). In other words, I am going to be doing every damn thing I can to avoid another C-section, because that? Was just awful.
People seem surprised at this, which vexes me for so many reasons. They act like I am doing something patently unusual, super-dangerous and risky! Which I am not. The larger reason it vexes me is simply the fact that there are an awful lot of C-sections these days, many arguably not necessary, and so relatively few caregivers willing to give women a shot at VBACs. Which gets back around to the whole high-intervention medical model of childbirth that prevails these days, that most women accept without question. (That is the subject of a whole other rant, currently in draft form. Just you wait.)
Back to the VBAC (Baby Got VBAC, VBAC In Black, Bringing Sexy VBAC, I've got a million, too bad for you). The majority of childbirth caregivers are not supportive of VBACs. The main reason is the looming spectre of that worst-case scenario: the uterine rupture. OBs in particular try to avoid medical malpractice suits, and most view VBACs as a possible path to one. VBACs are also not appropriate for all women. If you had the wrong kind of incision (i.e., not a low, transverse incision) for your C-section, if your prior labor was a "failure to progress" after a long labor, or if you had/have other complications (gestational diabetes, preeclampsia, etc.), you may not be a good VBAC candidate. But what women don't know unless you do some homework, is that the rates of uterine rupture are very small, and that contributors to uterine rupture in VBACs are (1) induced labor; and (2) labor augmentation, such as with pitocin or Cytotec. These are ultra-common in the medical model of childbirth, but also completely avoidable, in most cases. The sad thing is, most OBs don't know how a fully natural, drug-free labor progresses or how to truly support it. Neither do most women. You have to really step outside of the common medical model, and seek out information about how to give yourself the best chance of a drug-free vaginal birth. And you might have to fight the medical establishment tooth and nail for it. The simple truth is that most women don't do that. And the average OB isn't going to tell you that. (I'm not trying to attribute fault here, for the record. Though, I do wish more women would do more research into their birth options.) It just can be hard to find a caregiver supportive of VBACs.
So, I want a VBAC. The first thing I did was that as soon as that pee-stick was positive? I called the most kickass midwifery practice in the DC area that has a history of expertise and success with VBACs. I hoop-jumped and filled out forms and e-mailed until I got an appointment. The practice is very popular among us Type A Washington professional types, and typically fills up fast, with a long waiting list. (Which is interesting in itself - clearly, there's a demand for this kind of practice that isn't being met, childbirth professionals take note.)
This midwife practice isn't for everyone. They are dedicated to a natural, drug-free birth model. All births are in-hospital, and the midwives have a practically unprecedented and strong working relationship with the hospital's OB practice (there's a long history of the OB and midwife communities being at terrible odds). The midwives want good outcomes, so they don't take everyone. It sounds kind of militant, but I knew I was a good VBAC candidate, and frankly, I'm cool with almost anything to avoid being gutted like a fish again.
The midwives require that: (1) you be healthy, e.g. no current health problems and none in any prior pregnancy; (2) you adhere to their diet guidelines (avoid refined sugar, eat whole grains instead of refined "white" foods, lots of fruits & veggies, no processed foods, drink lots of water); (3) that you exercise, trying for at least 30 min. of walking every day; (4) that you have a doula for your birth; and (5) that you are committed to a drug-free natural labor. None of that was a big deal to me. I'm ridiculously healthy - my only medications have been Advil, the odd face cream, multivitamins, and wine. I had no issues with my prior pregnancy. We eat like that anyway, and rarely have dessert. I exercise anyway. I had a doula the first time (so frigging awesome -everyone should have one). I wanted a drug-free natural labor the first time, and I had it, right up to full dilation, the discovery of the breech baby, and the spinal block being stuck in me for the C-section. Also, I am not going to take this too seriously, and beat myself up for dessert once in awhile. Neither do the midwives. They just want you as healthy as possible. They also believe that a very healthy diet & exercise leads to smaller, healthier, babies, which leads to easier births. (The general idea being that a high fat, high calorie, high sugar diet grows bigger babies.) I'm good with all of that. I also had a 6 pound, 6 ounce baby the first time, and don't think it's likely that I'll grow a ten-pounder this time.
Now, if you are a VBAC candidate, it's a little more complicated. You have to have the low, transverse incision, stitched up properly, with the surgeons having done a "double layer" stitch, doing each layer of uterus and muscle and skin separately. Check! Also, anyone with a prior breech baby is usually a shoo-in. Me especially, since I progressed to full dilation. Women who had the dreaded "failure to progress" last time might not be good candidates. It's so complicated, the possible reasons why your labor might not have progressed. Everyone just has to figure out if it could be overcome this time.
There are a few extra things for VBAC labor - a hep-lock in place in case they need to give you IVs real fast, in the rare event of uterine rupture. Eh, whatever. I was Strep B positive last time, had to have antibiotics during labor, and it was really No Big Deal. They'll also be sure a surgical team is consulted and on call during your birth. They've actually had one uterine rupture in this practice, which actually gives me a sense of comfort. All went well, mother and baby fine. It just tells me they know what they're doing.
Am I nervous? Sure, but perhaps not about what you might think. I'm not worried about the Big Bad Worst Case. I know I'm healthy and strong, and that I healed well. My C-section scar hasn't bothered me at all this pregnancy, and every medical professional who's seen it was impressed at how not-visible it is. I'm doing as told, and massaging with Arnica gel...when I remember and am not passed out at 9 pm flat.
My labor last time was fairly short - 18 hours from first contractions to full dilation and pushing. With a malpositioned baby, whose head wasn't even pressing on the cervix. I also never cursed, screamed, or asked for drugs once (and I have many witnesses). I was in The Zone. AM LABOR ROCKSTAR. I feel confident about that part.
The parts that I am apprehensive about are actually pushing the baby out and delivering the placenta. I did everything but last time. It's the "BUT" that gives me pause, because that's where the pain and stretching and pelvic spreading and shit really hits the fan, as I understand it. One of my best friends calls her younger daughter The Glacier because "nothing is in the same place as it was before she went through." Um. Yeah. CONCERNED.
The placenta just seems, ew. I'm a big old tree hugger hippie type in many ways, but I draw the line at placenta worship and the other godawful things people do. (Doulas, etc. all ask you if you'll want to... keep it for anything. Nope. Biohazard bin, please, thx.) I'm kind of repulsed that I'll have to push that out too. I don't know why it gives me such heebie jeebies, but it does.
The best thing about this planned VBAC is the support that I know I have. We've hired a wonderful doula, who's a VBAC mom herself. I'll be with one of the most well-regarded midwifery practices in the area, that is deeply devoted to successful natural births and VBACs. I will have amazing support from all of them. I have the absolute support of my husband. Everyone who will be with me during labor & birth wants me to have a natural, drug-free labor and a successful VBAC, and they know what to do to make it happen. It's a really, really, REALLY good feeling to feel so comfortable with your pregnancy and birth caregivers.
Also, the hospital is across the street from a Whole Foods, so there is good food and liquor available ASAP, no matter what happens. Priorities, people.