To VBAC Or Not To VBAC

Sometimes it can't be avoided: serious topics. And I'm struggling to find much humor in this one.

At my last OB visit, my OB-of-the-day (there are four in the practice) wanted to talk about my upcoming labor and delivery.

An aside: this is my temporary OB as we have re-located for my husband's job … we are supposed to be back in L.A. before babe #2 makes her appearance. And a little refresher: Eli was born via c-section due to an abruption. There was also an issue of my pelvis "not opening," or so I was told, so I was also labeled as “failure to progress.”

At the visit, my OB told me that since my pelvis didn't "open" last time there isn't much chance of it doing so this go-round, and that I should seriously consider having a scheduled c-section.

I listened to her reasons and came home. My OB back in L.A. has told me I'm not the best candidate for a VBAC (vaginal birth after cesarean), but in previous visits, told me he would at least let me try.

As the hours after my appointment passed I found myself becoming more upset and emotional. I do not want another c-section if it can at all be avoided. I realize if it's scheduled, meaning: if I don't have the 20+ hours of labor, the abruption and THEN the c-section that my recovery will, in fact, be better. But it will still involve a surgical procedure and me being stuck in bed the first day attached to a catheter and those funky inflating leg warmers to ward off blood clots. I won't be able to immediately bond with or breastfeed my baby. I won't be able to hold her. This is devastating to me, again. Then there are the risks of having a c-section in the first place, and those do not diminish for repeat c-sections.

What I kept wondering was: Why are my healthcare providers so convinced my body isn't capable of doing this?

I went online and decided to do some research.

I posted a thread on Mothering.com (home of Mothering magazine). I know this particular crowd is pro-VBAC, homebirth, midwife, natural birth, etc., and I figured if there was an audience that would encourage and support me in my endeavor to have a VBAC this would be the place.

I laid out my birth experience and asked if any women had had a similar pelvis issue and gone on to have a successful VBAC.

It's worth noting that Eli was asynclitic before I went into labor, meaning he was head down, but slanted off to the side a bit. He was like that for several weeks before he was born, didn't flip for the longest time and was actually quite lodged in there. It was for this reason he was born with torticollis and plagiocephally (an issue with neck muscles; he also had a flat spot on his head). Well, come to find out his position was most likely responsible for my unyielding pelvis, as this is a common “side effect” of having an asynclitic baby. It's amazing what you can learn in an afternoon.

I dilated to a nine during my labor. Were it not for the abruption and had I been handling the sciatic pain (due to his asynclitic position) better, basically, if I had had more time (and no epidural), it's tough to say whether or not he could have been born naturally.

What I do know, after my frenzied research period, is that there are things I can do before I go into labor and even after I do, to encourage an optimal birth position for the baby and to prep my pelvic floor. I can visit a chiropractor, continue my yoga, hire a doula to assist me during labor with stretches and positioning to encourage the baby to move into a good position. Most of all, I will do whatever I can to avoid getting an epidural, as that hindered my ability to move around, thus ending any hope of assisting the opening of my pelvis.

These are all things I didn't know during my first labor, but none of them are absolutes. This baby may not be asynclitic. My pelvis may open if she is in the proper position. Will I have another abruption? There is no way to know. It is the one factor I cannot prepare for and the one big risk I will be taking in attempting a VBAC. Because I have already had one, statistically I am at greater risk of having another. That is frightening. Will it keep me from attempting a VBAC? I don't think so.

The point I’m trying to get at here is that if I only listened to my healthcare providers I would continue to believe that my body isn't "right," that it isn't capable of delivering a baby without surgery. In my heart I do not believe this. I was almost there last time. Had I been better educated (and supported) perhaps things could have turned out differently. That's the beauty of hindsight, and it means I will be better prepared this time.

I would like to think I've moved past my c-section. In most ways I have. All I have to do is look at Eli, at what a beautiful, smart, sweet boy he is, and I know the c-section, in that instance, was the right thing to do, it is what needed to be done to insure the safety of both of us. My problem is that without getting into the next labor, seeing how the conditions play out, I can't say with any certainty it would be the way to go next time.

Sure, if we get a few hours in and some of the same hurdles present themselves and we are not getting around them, well, I wouldn't hesitate to get the c-section. But if I can try and birth my daughter naturally, hold her, feed her, walk around with her on the same day she is born, well, that makes me tear up just thinking about it.

All I can say is be your own advocate. If you don't like what you're being told, do your own research and seek out the experiences of other women. Obtain and read your medical records. I guarantee they will tell you things about your medical history you did not know.

Ultimately, as was the case during my first labor, some conditions and issues cannot be prepared for and if that is the case, I will do what is best for the health of the baby. At the end of the day that is all that matters. But it doesn’t mean I don’t deserve a choice or a say in how my next birthing experience unfolds. I will prepare myself and hope for the best. It is all I can do; it is what I have to do.

An End, And Beginning

It's been exactly four weeks since I stopped breastfeeding Eli. I was hoping some distance from the event would give me some shiny conclusion, a pearl of wisdom to share, something meaningful to say.

That hasn't happened, exactly. We stopped and there hasn't been much looking back. Between my participation in National Novel Writing Month during November, which took every spare second I had (and yes, I made my 50,000 word goal and will continue to work on this novel), and Eli's seemingly-daily-increase of energy, well, there hasn't been much time for reflection. What I do have is my experience on that final day.

Here is what I wrote in my journal the day the milk ran dry…


* * * * *

11/8/10
Today has been an emotional day. First off, it was Eli's final day of breastfeeding. He has been down to one feeding, first thing in the morning, and it is the one feeding he has been resistant to give up so I've been taking my time with him. But today there was nothing left. The boob juice was gone. He sat up and looked at me, confused. When I realized what was happening and what it meant I felt conflicted. Was I really done breastfeeding? I had made it just over a year, a huge accomplishment for me. But was this it?

It was a bittersweet moment. When I look at Eli I know I will miss the connection we've shared for so long, but at the same time I swell with pride when I see what a little man he is becoming, how much he has grown and changed, how he is becoming more independent each day.

The combination of this event, coupled with all these disparate thoughts and feelings, started me off on shaky ground for the day. Barely an hour later we were at my OB's office for our "big ultrasound," where we also opted to find out the sex of the baby. I initially thought girl when I first became pregnant, but then for several weeks had no inkling one way or the other. Then in the last week or two my husband and I had convinced ourselves this babe was a boy.

There was an immediate crotch shot during the ultrasound and I swear I saw some junk floating around in there. The tech didn't say anything but in my head I thought I knew. So it was a rather big shock to hear her announce a couple minutes later: "It's a girl!"

My response? I asked in disbelief, "Really?" Then my eyes filled with tears.

Of course the tech thought I was moved because I was going to have a little girl to buy frilly dresses for and to take doll shopping. She immediately started telling us about taking her daughter to the American Girl doll store. This is not my idea of a good time, by the way.

No, I'm not sure where the tears came from, other than the joy of feeling like I now knew my baby just a little better, felt a greater connection to this little person squirming around in there. Perhaps it was the knowledge that while one connection was ending on this day, another was beginning.

It was strange for me to feel so emotional over this news. The circumstances had been different with Eli. I was going to acupuncture during my first pregnancy and ten weeks in my acupuncturist asked if we were planning on finding out the sex of the baby. I said yes. "Well," she said, "I can tell you right now if you want to know."

Well of course I wanted to know so I found out. No one believed she could know such things, but my husband and I had already suspected we were having a boy, and Cristina only confirmed it. So while we were excited for our "big ultrasound" for Eli, it was really just a safety check, and then a confirmation of something we already knew.

This time around it was a true surprise.

I spent the rest of today wearing a silly grin one minute and then teary-eyed the next. I would look at Eli, imagine him with his baby sister, and feel my heart swell. In many ways, it is probably the best possible day for us to stop breastfeeding, a day when there is other happy news to focus on, to distract us from what could otherwise be a sad and/or traumatic day.

* * * * *


Four weeks later we all move forward, Eli drinking whole milk like a monster (he loves it, thank goodness). I am thankful for a smooth transition, not one clouded with doubt about whether I did things the right way. Eli never seemed upset that he was no longer breastfeeding, never tugged at me. It's like we both knew: This time is over. It's time to move on.

Mostly, I am thankful that we made it. Breastfeeding for one full year was always my goal and so many times, especially in the early days, it seemed unattainable. By the time we finished it felt second nature, natural, like there couldn't be anything more normal in the entire world. I never thought any of these statements would come out of my mouth (or fingers) so that feels like true progress. It also feels like a wonderful way to move forward in preparation for our next babe, who will have a much more assured mother waiting for her.

This Milk Machine is closed, for a little while ;)