Saturday, September 3, 2011

VBAC Angst.

  • VBAC (Vaginal Birth After a Cesarean) is such an individual thing. 
    Some areas of the U.S. it's an accepted and encouraged option, easy to find support. 

    In other locations no one really VBAC's. It's just expected that since you had one cesarean, you'll always give birth that way. Hospitals out-and-out ban them. 
     In still other areas you are told you can "absolutely VBAC". But the area is so hostile towards VBAC no provider will take you on. Even the provider who did your cesarean. Yes the one that told you "VBAC no problem!" as they wheeled you out of the OR (it happened to me).

    On the hospitals part they don't say you can't VBAC. But they have extremely restrictive policies in place for both OB's that "allow" trial of labor, and Mothers who ask for one (ACOG's guidelines for VBAC).

    In still other scenario's an OB will say, "ABSOLUTELY I'll let you VBAC." But then some where after 36 weeks they'll pull a "bait and switch". An ultrasound is ordered and the baby is proclaimed to be "too big" (ultrasound measurements can be off by a couple pounds either way!) or the pelvis "too small". Or they will suddenly come up with other reasons and suddenly become very concerned about the "horrible dangers of VBAC".  They may even discuss some uterine rupture horror stories. They refuse to allow a trial of labor "given the new information based on the ultrasound", and mother is dropped from care if she refuses to schedule the cesaren (know your RIGHTS they can't do that!).

    I'm not just saying this, I've personally (as in, in-person!) heard from many many women who suddenly find themselves reeling because they thought their VBAC plans were set.

    My Situation... AKA MY ANGST!

    I, unfortunately, don't live in a great area for VBAC. Had I known the heartache and disrespect I would be exposed to in order to have a normal birth,  I sure as heck would not have consented to the first one so easily (and my hospital records say "ELECTIVE cesarean"....
    It was most certainly not posed as "elective" at the time. They told me Roo was in danger. Though looking back I knew in my heart she was okay...And being more informed now, knowing what I know about fetal heart rate: she was FINE. Her heart was dipping down a bit during contractions. But it was recovering WELL and the whole time was with in "safe" ranges. Had they turned down the pitocen the heart decels would, I am certain, not continued- and who knows what would have happened?).

    Hindsight is 20/20.

    In my neck of the woods there are two names behind the hospital campus'  in my area. These names (and teaching hospitals) are driven by deep (deep) pockets and a lot of politics. 
    The powers that be, do not approve of women who want a natural birth (and what I mean is low intervention: no augmentation, no anesthesia etc). Natural births 1) tend to take longer 2) make it harder to monitor/control what is going on ie., the staff actually has to be in the room interacting (gasp!) with the mother more often: not just watching the fetal heart rates from the nurses station. 
    Now, that is not to say the staff at these hospitals don't care, or aren't kind people! Most of them (in my experience) are working hard and very caring. But these maternity wards are big, and busy. With a lot of mothers and babies to be cared for. Not to mention, there is a lot (of money and grief) on the line if some thing goes wrong. Which means having a Mother labor off monitor  (so, not strapped in bed to a monitor. But moving freely with only intermittent checks on baby) and laboring on her own terms (walking around and staying out of bed) complicates the cookie cutter care they want (and need) to give, if there are many mothers in labor. (For more on this: Check out The Business of Being Born)
     So that's just natural (low-intervention) birth. Add to that VBAC (can we cue the dun dun duuuuuh). VBAC, like all birth, does carry some risks.  But not nearly as many risks as repeat cesareans (also this). Each woman needs to weigh the option that is right for her. And support and care should be given to her no matter what she decides is best for her situation. IT SHOULD BE ABOUT THE WOMANS CHOICE NOT POLITICS!

    Back in the 1980's, I was born at home. Into the hands of my Daddy...Surrounded by family and caring midwives. I always thought I would like to have a home birth some day. I strongly considered it with Roo, but didn't know how to find a home birth MW in my area. I did look, but all the MW's websites said they didn't deliver in or near my city (and I hate making phone calls if I can help it, so I never tried calling to ask). I figured I'd try it with my second baby...That I wanted to have "been around the block" with this birth business before doing it at home. 
    Then I had my unexpected (unwanted) cesarean. I tried to get a VBAC friendly provider but she more or less dropped me (after telling me some lovely VBAC horror stories) at 10 weeks pregnant with Friendly. I found a wonderful home-birth MW who was willing to believe in me, and my body...And was nothing but encouraging through my pregnancy and long labor. I loved my home birth, it was wonderful. I am hoping and planning for another beautiful (safe) and successful home birth for Newby. But I don't necessarily think home birth is the safest option for all VBAC Mom's. 
    If I could change one thing (and really the only thing) about my home birth experience it is the fact that I don't feel safe transferring to the  hospital in my city. I don't like the fact that because of prejudice in my area (against VBAC but also home birth) I can't get ANY back up care if a transfer is needed. I'd have to show up and get whoever is there. 
    I believe *I* am a great candidate for a HBAC for several reasons (not to mention I have had one already), I am healthy.  I have no per-existing conditions.  I am active and eat well and take great prenatal supplements.  I am mentally healthy and have a wonderfully supporting partner and trained birth team. And also an important factor: if I needed to transfer, I am literally 5 minutes from a big awesome hospital with a great ICU and NICU.  I don't plan on needing a transfer, I pray that all goes smoothly. 
    My problem? It's the hospital with defacto bans against VBAC. A hospital that has made it clear that they believe that home birth is dangerous (despite several studies that prove otherwise). Because of that, I fear for how I would be treated. I  hate that I do not have a relationship and understanding with an OB at that hospital. I fear for how my body would be cared for if I went there needing help. I fear that my baby would not get the quality care it deserves because of the decisions I made for labor or birth.
    So, if a need to transfer is becoming apparent, I would have to transfer to a hospital an hour away to feel (and perhaps BE) safe from prosecution or abuse (to me or my MW).
      I don't like being shoved "under ground".  I'm really not all that renegade. And I resent the fact that I can't have the full-care (a relationship with supportive OB) I want and deserve.
    I resent the fact that I will always be "A VBAC" (AAAH!). It doesn't matter what studies prove that the risks of VBAC decrease with every vaginal birth you have. Birth has risks. But it is also a NORMAL and NATURAL process (especially when you leave it be!), it is not a "accident [or lawsuit] waiting to happen".
    And so lays my angst. I want a home birth. But I want supportive back up care. I want my desire to labor at home to be respected. I want to be treated as an adult who has researched and made the decision that I felt best *for me*. I want to be able to transfer to the hospital and have my decisions respected and supported.  I don't appreciate showing up for a prenatal appointment (that I never got) and instead be told horror stories and warned that I very well may die because of my stupidity. 

    I feel angry that I ever had that wretched first cesarean in the first place. 

    And there it is... And nothing is probably going to change for me...But I am going to spend the next 20 years making sure it's different for my daughters. 

    That's all.

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