csection

Giving birth is a big deal. A lot bigger deal than our society makes it. After I gave birth to Peanut, I was lying in my Mother/Baby unit bed, feeling like a truck hit me just as I crossed the finish line of a marathon, and wondered, “Why didn’t anyone tell me this was so… huge?”

It is because birth is such a big deal that women should have full control over their deliveries, and how they’ll bring their babies into the world. Here in my state, and undoubtedly in countless more, options are disappearing.

I live in a midwestern state without a huge population. Nevertheless, we have big hospitals in several cities. In our state capital, there are two Level 2 trauma centers, meaning they are required to provide “24-hour availability of all essential specialties, personnel, and equipment1.” You can get C-sections there, and their OBs will treat you if your baby is breech.

You cannot, however, deliver your baby vaginally if you delivered a previous baby by C-section. Also known as VBAC: vaginal birth after cesarean.

There are many reasons why hospitals are wont to do VBACs, but in my humble opinion, a Level 2 trauma center has no good excuse for not offering them. The most concerning risk with a VBAC is the chance of a uterine rupture at the site of your previous uterine incision.

“Uterine rupture is rare, affecting fewer than 1 out of 100 women who’ve had a prior low transverse uterine incision — the most common type for a C-section. Still, it’s possible. And naturally, the risk of uterine rupture causes concern.
“If you’re considering VBAC, what’s important is to make sure that the facility where you’ll deliver the baby is ready to deal with that complication. You’ll need staff immediately available to provide emergency care.” (source)

Didja catch that? “Make sure the facility where you’ll deliver is ready to deal with that complication.” It would appear they are, since they offer emergent C-sections to other birthing mothers if they need one. So why not offer them to VBAC moms?

I think it’s a giant rip-off. The overall risks of a vaginal birth are lower than a C-section, and with each subsequent C-section, your risk for complications increases. But the providers don’t appear to care — it’s more important that their lives are easy and convenient, I suppose. The surgeons already at the hospital in case of other C-sections aren’t willing to add the scant possibility of a few more to the docket.

Maybe it’s a malpractice thing? They’re afraid of being sued in case of a complication. But a VBAC shouldn’t be categorized in the same bucket as a high-risk pregnancy. It’s simply not the case. And it’s not fair to a mother who wishes to deliver her baby vaginally, for whatever reason she pleases.

As it stands today, any mom wanting a VBAC in our state capital has to drive at least 110 miles to get one. Very realistic when you’re in labor, right? Especially with your second kid, or later, when deliveries are known to move faster.

I have friends in rural parts of the state who delivered by C-section, and upon getting pregnant again, went to see their OB. The word “VBAC” was never uttered. The question of how they wished to deliver wasn’t even asked. It’s unfortunate that the onus is on the mother to push the issue of a vaginal birth, when an obstetrician’s job is to treat the patient, and help her to deliver her baby in whatever safe way she wishes.

VBACs aren’t some weird rare thing that nobody does. I know several women who’ve had VBACs (I know none that tried and failed). One even had two VBACs! And she lived to tell the tale. Duh. *eye roll*

The downside to shrinking VBAC options: women who want them may have to turn to home births. While I’m not a personal fan of home births (mostly because it’s hard to get to the hospital fast enough in case of unexpected issues), I think home birth is an even worse idea when you have a potential complication like uterine rupture.

When hospitals eliminate options, and driving 110 miles to give birth isn’t feasible, what else is left?

 

P.S. – Did you get a section and loved it? Never cared to deliver vaginally after that? Good for you. The whole point here is that you should get what you want, whatever that is. More power to ya if it’s a VBAC, and more power if it isn’t.

 

P.P.S. – My friend in the capital city reported that she was told just within the last few weeks that she CAN do a VBAC at one of the hospitals there. Hooray! I was told about the no-more-VBACs thing back in July during an OB appointment (my OB was getting patients from the capital city because of the change). I’m happy to see that they’re back now, at least in that city. That said, they should still be available everywhere that a C-section is offered. Another friend who’s an OB nurse said that it’s related to VBAC malpractice insurance. I can’t believe there’s a separate policy for VBACs. How stupid. Ugh.

 

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