The birth center at Ashland Community Hospital called at 10:45 today with a VBAC patient dilated at 2 or 3 cm, whose water had just broken. They said she had requested a doula, and asked me to come right in.  Five years ago, Julia had labored with her first baby to 8cm, then the doctor realized the baby was breech and did a ceasarean section.

       When I arrived at 11:45, Julia was in the bathroom with her husband. She was pretty uncomfortable, and wanted to get in the shower. They stayed in there together for about half and hour, until things had obviously intensified, and she just wanted to go lie down.  We wrapped her in a warm blanket and helped her back to the room.  She was starting to panic, to say she didn't think she could do this.  She was afraid, and unsure if she could go on, if things would be okay, if she could deliver this baby vaginally.  We helped her focus on her breath, its rhythm, and assured her that things were intensifying because everything was going the way it should.  Her body was making space for baby to pass through.  The nurse checked her again and she was now at 5 or 6 cm. 

       In the bed we tried a few different positions, but she just couldn’t get comfortable, and was having a hard time staying on top of her breath. Her father, husband and I coached her with every breath to find her rhythm, to stay with it, to reassure her that things were going just as they should. I found a place to press on her lower back, which felt good when she laid on her side.  She seemed to stay with her breath as long as she had consistant support, but she was having a hard time handling her dicomfort.  I thought she could be in transition, and although, as a VBAC patient, they would not let her give birth in the tub, I thought it could help her to get in a relax for a little while.  She agreed and I went to turn on the water.

     By the time I got down the hall to the tub room and turned it on, the nurse signaled to me that her cervix was dilated and she was complete.    Very soon, Julia was having a hard time not pushing. Her doctor was on the way, and the nurses were getting ready.  She pushed her baby out in about half an hour with incredible strength and even moments of humor.  I held her leg, and took pictures as her little one was crowning and emerging into the world.  It was 1:50 pm, so I was there for only about three hours before the birth. Julia had been in labor since 5:30 am.

     This was my first successful VBAC experience.  I felt a layer of doubt and fear, as though she had some expectation, formed through her experience, that her baby could not come out of her vagina.   She had the support she needed, though, and her body and baby worked their magic! The baby was at least 9 lbs. and gorgeous!

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 VBAC is an incredibly political topic in the birth world.  Doctors in the United States are telling women who have previously had ceasarean section births that baby number two will have to be born the same way.  The driving factor in this situation is medical  malpractice insurance companies, who are faced with a growing number of  lawsuits from people claiming that an emergency ceasarean was not available quickly enough.

  One of the effects of the rise in malpractice suits, is that these insurance companies are targeting a procedure that research shows is reasonable and safe.  Many insurance companies are instituting strict standards of procedure for planned VBAC births, which can cost hospitals thousands more dollars to provide.  Many companies are excluding coverage altogether for doctors to allow women with a history of C-Section to attempt a Trial of Labor (TOL). If the doctors and hospital have no insurance coverage, they will not allow the procedure.

What are the risks of a ceasarean section?

Risks of this major abdominal surgery include hemorrhage, bowel obstruction, pain, infection, and tissue scarring and adhesions.  Bonding and nursing are challenged, and babies are more likely to be cut, born early, have breathing problems or weigh less.

What are the risks of VBAC?

Research shows that less than 1% of VBAC births result in uterine rupture  (1.6 per thousand.)  These studies have  included women whose labors were induced.  Pitocin and cytotec, labor induction and augmentation drugs,  create artificially strong contractions, so it is likely that  a study done with women experiencing spontaneous labor would have even lower chances of uterine rupture occuring.   Cytotec is not used any longer in cases of previous ceasarean, and pitocin is monitered closely to keep the dose under control. The risks  of the scar giving way were also greater when incisions were made vertically and higher, but the way the incision is made now, low and vertical, has much better results. 

Vaginal birth itself has a greater risk of continuing perineal pain or incontinence, and a greater risk of baby suffering nerve damage in the shoulder area.

This is a topic that women need to continue doing their research about, as doctors may just tell them that a repeat ceasarean is the best option.  Ceasarean section can be a life saving operation, if necessary, but the c-section rate in America is almost 30%.   Many healthy women are facing unnecessary risks from this major abdominal surgery.  90% of women who have had previous ceasareans are having repeat surgeries.  It is clear that ceasarean section has complications and risks, and the research leans toward those risks outweighing the risk of VBAC.

more online resources:

http://childbirthconnection.org/article.asp?ck=10166#systematic
VBAC research statistics

http://pregnancychildbirth.suite101.com/article.cfm/vbac_controversy
risks of c-section

http://www.mayoclinic.com/health/vbac/VB99999/PAGE=VB00009
The Mayo Clinic reports that VBAC is safer

http://findarticles.com/p/articles/mi_m0CYD/is_3_40/ai_n11832004/
insurance companies set standards for VBAC procedures

http://pregnancy.about.com/od/vbac/a/deniedvbac.htm
What to do if you are denied access to medical care for a VBAC

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