John and have been talking a lot about having another baby so I scheduled a preconception visit with the group of midwives that handled my pregnancy. I was due for my annual check up anyways or else I probably wouldn't have made an appointment specifically to talk about everything but I'm really glad that I did.
The biggest thing on my mind was whether or not I could attempt my much desired VBAC (vaginal birth after cesarean). I expressed to the midwife how important it is to me and how I want to attempt one. First of all, she said that midwives aren't allowed to do VBAC's anymore because there is a risk of uterine scar rupture during pregnancy or during labor. That alone stinks because I'm so comfortable with my midwives and the thought of going to a group of MALE doctors who I don't know is just plain awful to me. The second thing that she told me really bugged me also... She said that she doesn't think that the doctors in their practice will encourage me to do a VBAC because on paper I'm not a good candidate... Meaning that Brooke was an average sized baby and that I labored with no medical interventions that would have adversely effected my labor (like an epidural or something). She also said that short women often have a hard time delivering babies and I'm only 4"11.
On the other hand, she said some good things... For instance, she said that no two births are different. Even though Brooke wasn't an abnormally large baby and I "should" have been able to push her out, maybe she wasn't at a good angle? Or maybe she was just stuck? She said my next baby could be a totally different story and even if he or she is a whole pound heavier I might deliver it just fine. She also told me that she has 4 kids and after delivering the first one via C-section, she had her 3 subsequent children vaginally. She totally advocates VBAC's but they aren't something that she's allowed to do.
Apparently VBAC's are looked on less and less favorably these days because doctor's see repeat C-Sections as the safer way to go. I don't get that because having a C-Section is MAJOR surgery. How in the world could that be safer? Apparently a couple of years ago a woman who was attempting a VBAC (at the hospital where I delivered Brooke) had a uterine rupture and died. Scary stuff but still... The risk is like .01in a million. I guess that alarmed a lot of people and now they're extremely cautious with VBAC's.
Then she told me something that REALLY got me upset... She said that she advises me to wait until Brooke is 2 to get pregnant again to give my uterus time to heal. Give me a break!!!!! My uterus is just fine, thank you. She did an internal exam on me and everything looked really healthy and great so I don't see what the hold up is. I'm NOT waiting until Brooke is 2. I've never heard of such a thing. I'm going to go to a doctor and get a second opinion on that one because that seriously doesn't even sound right. I came home and did some reading online and it said that women who want a VBAC are suggested to wait 2 years, but it doesn't say anything about waiting that long if you opt to have a repeat C-Section. Everything I've read says that the uterus is back to normal about 3 months after the surgery. Either she's on dope or I just misunderstood? Lol
So, I'm frustrated. Yes, I want another baby but I want to go about it in the safest manner possible... If that means giving up my time frame or my strong desire for a VBAC then I guess I'm left with no choice. My family has to come first. I'm feeling kind of sad over all of this...
4 comments:
Hi, just came across this and wanted to give my 2 cents :) First I would say join ICAN-online.org, find a local group, and start asking questions. Then find a new OB/midwife who is supportive of vbac. From most research I've read doctors want 18-24 months between births, not before getting pg again. The uterus does most of the healing in the first 2 months after c/s so there's no reason to wait so long, unless your body just needs time to rest. My first was a c/s for CPD/macrosomia. They said my baby was too big. Really he was just malpositioned. I went on to have an unmedicated VBAC 20months later to a baby the same size. If VBAC is what you want, then you should do what you can to get the support for it :)
I agree 100% with Kara. My reading on VBAC, my doula and my dr all recommended 24 months between c-section and VBAC attempt.
On the midwife front - your midwife might be bound by some rule about VBAC, but midwife's in general are not. There are midwives in my town that oversee home births after 1 & 2 c/s ~ providing everyone is in good shape and in the right position.
Seek out another midwifery group for your second opinion.
CNMs are not allowed to do VBACs. Licensed and Certified Professional midwives can at their discretion and with the woman signing consent forms. Unless a birth center is owned/run by LMs/CPMs, then women wanting a VBAC cannot deliver there.
It is common practice to encourage women to wait to have their babies 2 years apart after a cesarean. Not get pregnant after 2 years, but you birth one and then birth the other one at least 2 years later. Several reasons for that including a woman's total health, the increase amount of scar tissue with time passing and the building up of red blood cells so a woman isn't anemic at the time of the second birth. Anemia doesn't *cause* bleeding, but a woman who bleeds can't bleed as much without being compromised if there aren't loads of red blood cells to support her.
The risk of uterine rupture isn't one in a million. It is slightly less than 1 in 100. This is important to understand before choosing a VBAC. This does NOT mean that every rupture or dehiscence ends in death for mom or baby, but it CAN lead to damage or death in one or both if left untreated by another cesarean. Under-estimating the risk of uterine rupture doesn't show your care provider that you are well-informed about your choice for a VBAC. Choosing VBAC is a wonderful and extremely viable option, but acknowledging the risks is a vital part of INFORMED consent.
Having a baby before 18-24 months after the first birth raises the risk of uterine rupture by 2-3 times. The longer between babies, the better off your scar.
Allllll that said, if the woman understands the risks AND the provider is strong in her belief and understanding of VBAC (and has experience with these powerful women!), then VBAC is a glorious and wondrous experience. I adore serving VBAC women. I've been the midwife for about 2 dozen VBACs, some VBAmC (one after *4* previous cesareans!)
There are ways to find the providers who support VBAC. ICAN is a vital organization to join as you discover where and with whom to trust with your choices. La Leche League is another place where you can find information about supportive care providers. Some people find calling Labor & Delivery wards helpful... asking, "I'm wanting a VBAC. Can you please tell me which doctors support this?" You might get the unsupportive bitch-nurse who wants to read you the riot act (hang up!) or you might get the nurse in midwifery school who loves loves loves working with VBAC women and she'll give you a list to look into.
Much good luck and keep telling us about your experience!
Hi! Ditto on the 18-24 months - you just had major surgery. Give your body some time to heal... and for you to process. That said, I had a VBAC at home and it was so different than my cesarean. To be able to eat and drink immediately after birth was so nice. To be able to go potty within an hour was wonderful. To be able to turn over in bed without waking from the pain was priceless. To not be high from drugs and be able to immediately hold and breastfeed my baby... to not have to wait in the recovery room for hours to feel my legs... I could go on and on. There is simply no comparison between my CS and my VBAC. You can read my birth story here: www.vbacfacts.com/hbacbirth, why I chose to vbac here: www.vbacfacts.com/vbac, why I chose to have a homebirth here: www.vbacfacts.com/hbac and how to find a good OB or midwife here: http://vbacfacts.com/2008/03/08/finding-a-vbac-supportive-ob-or-midwife/. :) Big hugs, Jen
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