Considering a VBAC

I like what NavelGazing Midwife has to say about the process of considering whether to have a vaginal birth after a previous cesarean, or whether to choose a c-section for a subsequent birth. She says in part,

I encourage you to start a list, even from the very beginning of research. A column for Risk of CBAC and then another for Benefit of CBAC. Then do the same for VBAC. As you learn, put your thoughts into those columns. I promise, as you read more and hear about more, your risks and benefits might flip flop several times. But, having the columns allows you to keep a somewhat logical head about the impending decision.

Then from VBACfacts, a post titled,

An OB you like or who makes you comfortable isn’t enough

It includes a letter from a woman who just had a repeat Cesarean after wanting a VBAC. She begins,

It is with great reluctance that I submit payment to you for services rendered.

I hired you for an intervention free VBAC.  Instead I had EVERY intervention I told you I did not want.  Under your care, I failed in the most basic way a woman can fail – I failed to birth my children.   You ignored each and every point on my birth plan.  I cannot help but wonder if you even read it, or if you ever had any intention of following it.


4 Responses

  1. Kathy, I think that is unfair. IF a woman is progressing beautifully and wants a VBac well more power to them. But who knows what the story was with this nice lady. YOu cannot choose your birth like you pick out a sub at a subshop. Things happen.

    Any Doc who promises you a Vbac or a Vag delivery is not being honest. We never know when the shit is going to hit the fan.

    What NGM has said has merit. But when you are having the baby, it is not like Burger King! YOu cannot specail order.

    The best you can hope for is that the hospital you go to can do a c-section in less than 10 minutes.

    • That’s true — a VBAC is not a guarantee. But what I got from the woman’s letter, which makes me think that her repeat C-section was probably not strictly necessary, is the following, “I knew going in that you had a high C-section rate, that you had already given me most of those interventions with my first child. But I liked you, and allowed that to influence my decision.” She went to Burger King and asked for a steak. She knew that her care provider had a high C-section rate, when she didn’t want a C-section; and also that he was most likely the reason she had gotten her first section, which she didn’t want. If a doctor has a 80% episiotomy rate for first-time moms, what do you think the likelihood is that he will find a reason to give you, a first-time mom, an episiotomy, even though many care providers have episiotomy rates in the single digits, or low double-digits? If a doctor has a 50-70% C-section rate, although he does not serve a super-high-risk population, what do you think is the likelihood that a significant percentage of those C-sections are in fact unnecessary?

      Here’s a different VBAC story — the woman also had a long and slow labor, but still had a vaginal birth. Perhaps if the first woman’s doctor had been more patient, it wouldn’t have been “necessary” to intervene in the other ways.

    • I am the woman who wrote that letter.

      I did not pick VBAC for my child’s birth the way I would picked “turkey – no – ham – no – roast beef!” To insinuate I did shows you lack the ability to understand WHY a patient would want a VBAC – that it was a whim and not a well researched decision.

      My birth plan contained “wishes”, such as no vaginal checks. Research has shown every woman dilates at her own pace, and vaginal checks can introduce bacteria. Yet my doctor pushed me over and over again to have them.

      It also stated I did not want pitocin. My doctor agreed – “no pitocin!” Yet during labor it was “well, let’s just use it to augment your labor.”

      I have a dozen or so other examples. My birth plan was not asking for things like 700 thread count sheets. I asked for things that research showed were the safest for me and my baby.

      I was in good health. My baby was in good health (and 2 pounds smaller than their ultrasound guess). As I told my doctor over and over during our prenatal visits, I wanted his job to be to sit there and be bored and WAIT. I was willing to go for as long as it took. He was not.

      I would have discussed it with him after the surgery, but his partner, whom I had NO IDEA would be providing my postpartum care, informed me he had left on a skiing vacation with his family, and I never saw him again. I will leave it up to you to determine if that played a part in my surgery.

  2. Wow, that is a powerful example of the importance of choosing your careprovider wisely!

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