An Unanticipated Choice: VBAC or C-Section?


I have to admit I was pretty surprised to make it into the second trimester. Despite having a reassuring listen to the fetal heartbeat at about 10 weeks in an unrelated doctor’s appointment, I still wasn’t completely believing that it would make it through the first twelve weeks intact.  But at my 12 week checkup everything looked perfect, and I was hit with a something else I never thought about — how I want to give birth.

I had made the assumption that, just like the last time I was pregnant, my only option was to have a second c-section.  When I told my doctor, who is a general practitioner, that I was pregnant last September, he informed me that he couldn’t see me anymore until I had found a surgical OBGYN who would be performing a c-section on me, since he wasn’t qualified.  If that doctor was willing to share duties, then I could continue with my regular doctor with the understanding that I would switch to the OBGYN closer to full term, and schedule the c-section then.

But now, six months later, a change in both insurance providers and hospital policy has brought a new set of possibilities into my life.  I could actually go with a VBAC (Vaginal Birth After Delivery). And, in fact, my regular doctor was encouraging me to do so.

I need to be honest.  Part of me liked having the choice taken away from me.  A c-section appealed to my sense of order: I would know exactly when it would happen, what to expect, how long it would take, what the recovery would be like.  And yes, it is surgery, with additional complications and a longer period of recovery than a vaginal birth, but still, I knew exactly what I am getting into.

I had a very bad birth with my daughter.  After going overdue I underwent a two-day long induction period that did not do what it should to jump-start delivery.  Unfortunately, my water broke on its own near the end of the process, forcing us to continue on right when I was about to be sent home to rest and try again the next morning.  Fifteen hours later, after four epidurals, six hours on oxygen, a raging fever, an alarming increase in fetal heart rate and a diagnosis of “failure to progress,” it was agreed that an emergency c-section was the only option. I started the induction at 9 am on Monday and at 3 pm on Wednesday was the semi-conscious mother of a fat, crying little girl with an undiagnosed infection that passed on to her due to my prolonged broken water.  She spent ten days in NICU, I spent three in my bed trying to recover from severe blood loss. 

Once we were finally all home, we quickly recovered physically, but it took me months to come to terms with the loss of a happy, engaged labor.  There was no joyous moment when the family all came in to see their first grandchild with balloons and flowers.  Instead, we escorted each grandparent into the NICU one at a time, due to the visitation rules.  In the end, I know I should have been happy she recovered so quickly, that she was released before Christmas, that I didn’t need the transfusion the doctors were debating giving me.  But still I think about that wonderful birth moment we should have had, and still find myself sad.

I realize that with a VBAC I have the chance to recreate that day, to attempt to have the experience I felt like I was robbed of before.  So many things would be different this time.  This time I know that I am Group B Strep-positive, and would be on antibiotics, making the danger to the baby that much less.  I came into this pregnancy nearly 40 lbs lighter than my previous pregnancy, making me a much fitter and healthier patient, something that has great effect on how often you end up in complications or stalled labor.  They do not give pitocin to women who have had c-sections due to possible rupture, so I will be able to move about during labor, rather than be laying in bed the entire time like I had to for my induction.  In fact, they don’t allow any form of induction at all, meaning if I do go overdue I would end up with a c-section anyway.

Because that is my biggest fear.  Not a fear of labor itself, but of going through labor, failing again, and having another c-section after already pushing my body to the brink.  If I thought in any way that I would fail, I would rather just go straight to the surgery and deal with its consequences on its own.

But I can’t help but think that if my body manages to go into labor on its own, it’s already a victory, as I never did manage to do so with my daughter.  If that can happen naturally, of course it would make sense that I could labor and deliver on my own as well, too.

I change my mind nearly constantly, and I know that luckily I still have months before I have to make a final decision.  I weigh what would be best for me, best for the baby, best for my family, who would have to help care for me somewhat, too, in the case of surgery.  And in weighing all of these pros and cons I have to take a moment and look at my own fears, and recognize that those have to be viewed as a factor as well.

But mainly, as I think my way through the scenarios I find myself amazed that I get to decide this at all, and realize how lucky I am that, after everything we’ve been through, there might be any sort of delivery at all in December.  Finally, I think I can begin to think of this pregnancy as real.

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  • doublejen

    Robin,

     

    Congratulations on making it this far! I’ve been following you on Twitter for a bit and it’s been great to read your story.

     

    I’m wondering how far overdue you were allowed to go with your daughter, and how far you will be allowed to go with this pregnancy.  My first was 2 weeks late, but I went into labor on my own.  Perhaps if you’re given enough time, you’ll have a better chance of a successful VBAC (or, of course, any VBAC, since they won’t induce you).

     

    Good luck with what I’m sure is a difficult decision.  Looking forward to learning what you decide!

  • radicalhousewife

    Congratulations on the choice you’re making!  It sounds like you are armed with the information you need, so humor me as I give an additional bit of advice, the tip I give every preggo I meet: do prenatal yoga.  Do it daily if you can.  I did Shiva Rea’s Prenatal DVD that I swear helped me sail through my second birth with no drugs, no problems, nothing!  of course, I didn’t have a c-section my first time to complicate things, but I do believe that the breathing and stretching exercises really helped prepare my body for delivery. 

     A great source of support for VBAC is The Feminist Breeder, who also has written for this site.  Check her out at http://www.thefeministbreeder.com.

     

    Keep your fans posted!

     

  • gina-crosleycorcoran

    Robyn – the majority of us who end up with cesareans get them because of a failed induction.  Have you seen the movie The Business of Being Born?  That could help you understand that what happened to you is not Birth’s fault, it’s the fault of the system that treats mothers like laboring cash cows.

     

    I highly recommend researching the real health benefits to both you and your baby by trying for a VBAC.  There’s plenty of information on my site, or start at http://www.VBACFacts.com.  What you will find will shock you, and make you wonder why you ever doubted your ability to birth normally to begin with.

     

    Good luck with your birth.

  • gina-crosleycorcoran

    Thanks!  You must have been posting that while I was posting my comment :)

    Jinx!

  • robin-marty

    I was 8 days overdue with Violet when we started the induction.  We’d had a dating ultrasound back at 9 weeks, so we were pretty confident of the due date, but the ultrasound before the induction was decided on, they were worried she was getting rather big, and there were some concerns that maybe I was a little further along than we had thought. 

    So far, it looks like our plan will be that I’m allowed to go 10 days overdue this time.  My due date is the 17th of December, and I believe we will set up a csection for the 27th.  This is an absolutely horrible thing to admit, but I don’t want to go any later than that, because we have a very very large per person deductible in our insurance plan, and because it is birth the company counts it as two people.  We can afford to do it, but if we hit a point where the hospital stay ends up straddling two calendar years, we’ll have to pay the deductible twice, and I have no idea how we can afford that.  Giving birth should not cost as much as buying a small car.

     

  • doublejen

    That’s amazing. Regardless, get yourself out of the hospital by the time the ball drops!!  I hope it all goes well, no matter what the outcome (a healthy baby and mom aside, of course!).

  • jesskm

    As mother who has experienced multiple losses and a childbirth educator, doula and IBCLC who has had the privilege to accompany a number of families on their journeys your ongoing experience has resonated with me on many levels.

     

    Looking into the unknown (which birth and parenthood are by definition) is often difficult, but doing so after having experienced “that which can go wrong” is even more so.  In my experience when a mother is able to sit with and explore her fears, as you are doing here, she is often more likely to feel at peace with her choices and their outcomes, regardless of what they are. 

     

    If you have not picked up _Birthing From Within_ you might consider doing so – it is a wonderful resource for dealing with the ghosts of birth.  Additionally if you can find a local ICAN chapter the leaders and mothers in attendance can be phenomenal resources.

     

    As you continue to consider your first birth and your options for your next one fact that might be of interest is that the *average* first time pregnancy is 41 weeks and 1 day – so in biological terms you weren’t even past due with your first-born and going a couple of days past the 41wk1day mark is totally and completely normal.  The average subsequent pregnancy is 40wks3days – but some moms just cook babies a little slower.  I am always very certain of my dates (NFP/charting) and have found that my only baby who came out with a gestational age of 40wks was my one that went 10 days “over due” – my babies that were born a couple days past their “due dates” where all 39 weeks gestational age.

     

    I just want to tear my hair out over the insurance issue.  This is a common problem and one that I have families dealing with every December.  I am so, so sorry that it money interferes with anyone being able to make optimal decisions regarding health care and can only hope that some of the changes in the works will contribute to this being less of an issue.

     

    Please continue to share your experiences and I wait excitedly to hear that you are holding this new little one in your arms.