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Monday, December 20, 2010

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.

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