The right to try

My second son being weighed at his first in-home midwife visit, two days post discharge.

Recently, I had an e-mail from a friend who is expecting her second child. Her first was born by emergency c-section and she has her heart set on trying for a VBAC (vaginal birth after cesarean). As her due date approaches she’s very worried it won’t happen because of a recent ultra-sound that indicated a large baby. She wrote to me because she was so upset and heartbroken and worried that her OB wouldn’t give her the chance to try. Beyond the problems associated with using ultra-sound to determine the size of a baby, her e-mail fueled my passion for informed-choice care.

With informed choice, care is provided in a non-authoritiarian relationship. The woman is seen as the ultimate decision-maker and information is given to allow her to make well-informed choices. It’s one of the primary reasons I chose to have midwives to provide my obstetric care for both my pregnancies.

Midwifery is a model of care that is holistic and unparalleled in many obstetric practices. Midwives focus on the whole health of the mother and counsel on not only the physical aspects of pregnancy but also the emotional challenges. They look at the whole picture, not just the science.

Both my children were born by unplanned c-sections. The first was devastating, so much so that I struggle with the circumstances around his birth to this day. I knew even before my second pregnancy that I would try for VBAC. I had a desperate need to get it right, to experience the beauty of child birth the way I believed it should be. I was obsessed with it.

My midwives were completely supportive, but also always honest about it. I would be given the opportunity to try with the understanding that my health and the health of the baby were the priority. They acted as advocates on my behalf, and with their compassionate guidance I was able to try to deliver my second son vaginally. I went in prepared, ready and completely comfortable with the idea that it might not go as planned. I went in prepared because I felt I had the full support of my pre-natal team. They were pulling for me and it empowered me.

So when I got this e-mail from my friend, I was predictably emotional and worried for her. I understand in a primal way how much a VBAC means to her. I’m concerned that her fears will materialize and her OB will recommend against a trial of labour. I’ve heard this story so many times. I even experienced it myself. The hospital I delivered at requires all midwiferypatients seek the counsel of an obstetrician before consenting to a trial of labour. This is usually done by the OB who performed your previous cesarean. My OB declined the consult because he felt “I was more motivated for a VBAC than he was.” Though I wasn’t surprised because of the circumstances that surrounded the birth of my first son, I did find his response callous.

So I offered her the only counsel I could. I told her to not be afraid to stand up for herself and to insist on the chance to try for a VBAC. I cautioned that while it may still lead to a c-section,  no two labours are ever the same, including the emotions surrounding each labour. I encouraged her to be firm with her OB and honest about how much the chance would mean to her.

 Both my children were delivered into the hands of obstetricians. There is still lingering pain because of what I feel I missed. But I was never led to believe I couldn’t do it. I was empowered to take charge of my birth experience. I was supported. As all women should be.

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36 thoughts on “The right to try

  1. Corinne says:

    This was so very well written Christine. It’s such a hot topic, but you presented it in an open way. Keeping the conversation civil, and supportive is such an important thing (especially between patient, OB, and midwife…)

  2. Amber says:

    This is so eloquent.

    While I haven’t had a C-section, I did use midwifery care with both of my babies, and my first child was born prematurely so there was an OB in attendance. And I can tell you that having my midwives there advocating for me, informing me and respecting me made all the difference. Birth doesn’t always go as planned. That’s unfortunate. But for me, and I suspect for many women, following the plan matters less than being involved in the plan, and respected in the process of birth. The truth is that we are the ones who will remember that day forever, and carry all the events with us for the rest of our lives – not our care providers, as well-meaning as they may be.

    I hope that your friend is able to have the birth she wants. Or at least to try for it, and to have her wishes respected and honoured.

    • Christine says:

      Yes Amber exactly! I think it makes all the difference if we are empowered tohelp make the decisions, with the right information. That we know that what we want counts too.

  3. Rudri says:

    Christine: I understand the need for natural birth and a loving environment, but I believe technology is a wonderful resource. For me, a hospital environment and the experience of doctors is a source of comfort. I respect people who choose to embrace a more holistic approach, but it is also important to emphasize the modern advancements that have helped many women and their children.

    • Justine says:

      Hi Christine, I don’t think I could have worded it better than Rudri, so yeah, what she said 😉

      Thank you too for sharing your experience with your midwives. I often wonder what their role was, apart from the descriptions I read about what they do, and you’ve described them in such a way that makes better sense to me than anything I’ve read.

      It seems like they do provide many women a source of guidance and comfort, but as Rudri said, being in a hospital, surrounded by modern techonology and experts in their field, was my source of comfort. My ob/gyn was wonderful and worked well with me, so I’m not sure I would’ve had it any other way.

      • Christine says:

        I agree, we’ve made leaps and bounds and that women should feel confident to have their babies in whatever way is most appropriate. For some that means home birth, for others hospital birth. I never contemplated a home birth, it didn’t feel right for me. I think the key is empowering women to make decisions with all the right information and not forcing them to decide based on bias or fear. I’m glad you had a wonderful experience, and I hope I didn’t leave the impression that I believe all OBs to be insensitive. I believe the opposite to be true in many cases. The OB who presided over my second C-section was the model of support and kindess, completely the opposite of the first.

  4. Miranda says:

    This is a wonderful account of the desires for a VBAC. I had an unnecessary c-section with my first and my quest for a VBAC with the second does seem to border on an obsession sometimes. However, I know in my heart and soul that I will feel differently about a repeat c-section if I’m at least given the opportunity to try to VBAC. All women should be given that opportunity.

  5. Nicki says:

    Having had all types of births – vaginal, emergency c-section, VBAC, and planned c-section – I am with you, Christine, on women having the information and ability to choose. I was heartbroken when I finally went into labor for my planned VBAC and my OB was out of town. The midwife in his practice came in but because – after having the twins – I was considered a high risk pregnancy, I had to have an OB as my primary care giver for prenatal and delivery. The nurses told me from the start that they were not sure that the on call doctor would agree to a VBAC. I stood my ground. I delivered a 9 pound, 1 ounce baby via VBAC.

    While not in your area, I would check out the web site of BirthNet of the Finger Lakes – http://freeourmidwives.org/about/birthnet-of-the-fingerlakes/ – for information and advocacy groups.

  6. Karen says:

    My son was born via C-section because he was a large baby (due to gestational diabetes). Like you, it’s my full intention to go into any future pregnancies with VBAC in mind. Yet, with a history of gestational diabetes, the chances of having a section are great. What bothered me the most about my first birth experience was that my OB immediately suggested C-section instead of giving me the chance to try to give birth to my son naturally. I didn’t know I could speak up for myself and say no to her suggestion. She pushed me hard and presented worst-case scenarios about tearing and other issues. In her mind, my body could not handle giving birth to my baby. Or, it was just more convenient to schedule surgery.

    Like you, I still struggle with what happened around my first son’s birth. I’m thrilled that he is healthy and thriving. I came out of it healthy, too, and even had a pretty easy recovery. But I wanted to give birth naturally and I don’t know how to get past my failure in that regard.

    Great advice – even for first-time moms. Having an advocate is extremely important when you feel strongly about a certain path.

  7. Lindsey says:

    I agree with this so fully – informed birth choices are a passion of mine, as well. I think the panic and fear that the media and medical establishment have created around birth for many women are a tragedy at best and a crime at worst. Honestly. Birth can be one of the most powerful and inspirational experiences of a woman’s life, and even the option of that is being taken away. I am sad for your friend and hope she gets to try for a VBAC as she wanted.
    Have you heard of the case where the baby was removed from the mom’s care after she refused a c-section? Appalling. Horrifying. See here:
    http://www.adesignsovast.com/2009/07/841/

  8. This is great, Christine, and I hope your friend reads your post and the comments. I’ve talked about my VBAC experience before. I switched to a midwife in my third trimester (actually, today is the anniversary of the first day I met my midwife, so your post really strikes a chord with me!), and never regretted it. She was the same–honest, forthright, but supportive. It seems OBs make a woman have an ultrasound if they want a VBAC so they can have further proof that a VBAC is a bad idea. Typically, second babies ARE larger than the first. I thought I’d have an ultrasound (my OB said he wanted it), but when I switched to a midwife, she said it wasn’t necessary, that ultrasound machines are notorious for being wrong about the size of the baby, and that the size of the baby is not a determining factor for whether a baby can be born vaginally.

    If I had stuck with my OB, I wouldn’t have been able to have a VBAC. Here’s why:
    1. I didn’t go into labor on or before my due date. I had to be induced. An OB would have just scheduled a C-section.
    2. It took a while for my labor to respond to Pitocin.
    3. I pushed for three hours. After an hour, an OB would have pushed me into surgery.
    4. My baby was 9 lbs., much to my shock. If I had had an ultrasound that showed this, I wouldn’t have been able to deliver her vaginally.

    I cannot say enough about midwives and doulas. It is so important to have an advocate, not a surgeon. (Not to say surgeons can’t be great, too, but we need to revive midwifery.)

    • Christine says:

      I agree Jana. It’s so hard to make decisions when in the heat of labour – an advocate such as a midwive who has taken the time to really learn your wishes prior to labour can make all the difference.

  9. LZ says:

    Well said…
    I’m not sure how I would feel if my births had not gone somewhat according to my expectations, but I do know that I would want choices, or a least objective, straightforward information. I believe every mom has the right to make the ultimate decisions in their care, but I think the right choice is a combination of a doctor/midwife presenting an accurate, unbiased assessment of the risks to a mom who has an open enough mind to know that things don’t always work out as planned or hoped.

    • Christine says:

      Exactly! Accurate and unbiased. I agree. I also agree that moms should go in completely understanding the situation. With my first birth I never imagined I would have a c-section. The thought never crossed my mind. I think had I given it some food for thought prior to labour I might not have struggled with it so.

  10. Finding the right team for giving birth is SO important. You need someone that you trust, that you know, and that knows you.

    I choose a family doctor to deliver my son. She was my doctor, saw me all through my pregnancy, delivered my son, and is also his doctor. I knew going in that she would deliver him {unless uncontrollable circumstances prevented it}. I was by far more comfortable with this than going to a doctor that included other doctor’s in the practice, and having the doctor on call deliver my son, rather than my doctor.

  11. Beautifully written. And as Nicki said, women need information. However, I would also say that we shouldn’t be “coaxed” into an attempt at VBAC when it isn’t advisable.

    I think we have far too many (romanticized) “shoulds” when it comes to childbirth. It skews expectations. VBAC is lower cost for hospitals/insurance companies, and thus the (ahem) push for it – whether or not it’s the right thing for the mother. My C-section was also emergency, following about 18 hours of extremely painful labor in which the epidural was not working. Some of us are too tiny (and our babies too big) and thus, C-section is exactly the right decision.

    Let me add that with one C-section and one VBAC, as a small woman, I’d take that C-section any day. I was forced into the VBAC and it wasn’t pretty. The real joy is in being handed a healthy infant, and in the years of the parenting process that follows.

    • Christine says:

      Thanks Wolf! Alas, being too tiny was my problem too. The OB who presided over my first son failed to explain to me. I laboured a long time to, 30 hours with my first son. But I felt I had to try again with my second. To be quite honest, had the first OB been more caring and well-intended and taken the time to explain to me what my second OB did I think things would have been dramatically different with my choice for a VBAC.

      Your perspective is well-taken! 🙂

  12. Elaine says:

    Such great comments. I hope your friend can find peace in knowing that either way her baby comes into the world is fine. I COMPLETELY understand her desire to birth her baby vaginally and the “regular” way but in the end it’s really about her and the baby both being fine.

    I myself had to come to grips with c-section being what I felt was the best choice for my second and third births. It wasn’t easy. Any of it. But I have a total of three beautiful children who came into my arms eventually and safe and sound.

    Good luck and good vibes for your friend… 🙂

  13. i LOVED having midwife care for both my babes and was thankful to deliver them both vaginally. i’m so sorry to hear that you didn’t get the birth experiences you sought, but at the end of the day, having your babe here safely is what matters–no matter the process. i hope your friend has doctors who are as respectful and understanding as your second. everyone woman deserves to make informed birth choices without being railroaded by an inflexible OB who “knows best.”

    there are some good links on VBAC here: http://crunchydomesticgoddess.com/2010/02/07/today-show-guest-post-c-section-childbirth-resources/

  14. I hope your friend is able to have a successful VBAC! It’s great that you were there to be supportive of her.

  15. Hyacynth says:

    Christine, you are right on — EVERY women should have the ability to make an informed decision for the labor and delivery of her child AND have her wished respected. I’m so glad to hear you were supported in your decisions by your midwives even though you did not have the births you had hoped. It must be hard to have not had what you so desired. My first labor and delivery were not what I wanted either. But I still feel grateful that I walked out of the hospital with a healthy (albeit colicky, I’m sure in part due to the medication) baby. I’m very, very grateful. I know you are too. But it still doesn’t erase the pain of dashed hopes for the birthing days. Thanks for sharing this story.

  16. Kate says:

    Birth is so loaded. I think it’s esssential to find peace through getting information, making choices, feeling confident in your choices. And knowing that sometimes things just can’t go according to your plans. My first birth, not terribly dramatic but not as I would have wanted, taught me that. The second time, I tried to go more along my own lines, and although many of the same choices were made, I feel more at ease with the experience.

  17. Stacia says:

    Understanding your body and your choices are so crucial. I know so many women who assume what their OB tells them is the straight-up truth and they never think to arm themselves with more knowledge or a second opinion. And I don’t necessarily think OBs are lying to women, but they certainly have their own agendas. (Maybe that’s understandable given the culture of liability we live in?) Either way, it’s a situation that too often prevents women from taking charge of their own prenatal care.

    That being said, when you do take the time to plan for your ideal birth experience and it doesn’t work out, it is so tough to come to terms with that. So very, very tough.

  18. Pam says:

    I wonder if things have changed in the last 15 1/2 years. My first daughter was born via c-section after a long and unproductive labor. When I was pregnant with my second daughter, I was given the choice by my OB to schedule a c-sect or to try for a VBAC. I tried for VBAC, but ended up with another c-sect. It seems that OBs now are not as open to the choice. Perhaps there is more malpractice today, though it was high in the 90s as well.

  19. Melissa says:

    My first birth was stolen from me by an unscrupulous OB. I knew nothing at all when I became pregnant and on the exam the week BEFORE my due date she choose (with our consent or consultation) to strip my membranes. Which lead to my water breaking and me not being in labor. 20 hours of pitocin later and no regular contractions or progress I had an emergency C (and a new OB).

    My new OB was very open, and asked me over and over again if I wanted VBAC. If I knew then what I know now (my hips were horribly misaligned reducing the available space for my big babies head) I may have tried, but my husband and I were so scared of ending up in the same place, long labor still having a C. I could barely hold my first for weeks after and I didn’t want that again. I scheduled a C and it was a dream as I felt great and was able to really care for and bond with my baby.

    This is so well put, the important thing is everyone has a choice. I choice a c, my girlfriend choose to VBAC at home with a midwife when her OB said what yours did, I cannot support you on trial of labor (she was predicted to have a big baby and is a small women). I think the most important lesson is, even if your weeks from labor, if your OB is not meeting your needs, making you uncomfortable or not listening, you need to find one that will, they are out there!

    • Christine says:

      I think you make an excellent and important point Melissa, about finding the right caregiver. I’m not sure it’s always easy, but I also think women should feel empowered to find new providers if the one they have isn’t appropriate or willing to listen.

  20. I had 3 regular deliveries (with wonderful pain medication), one crash c-section (a true miracle of God that he had APGARs of 9 both times, and a planned c-section due to the type of delivery with the crash c-section. I LOVED the planned c-section – because of how they, ahem, are able to tidy things up, it made a much more comfortable recovery – and I was able to focus more on this wonderful, new baby. However, a woman needs to be supported in the decision by her doctor to help her have the kind of delivery experience she wants. I was concerned about minimizing the pain – because the recovery pain of the crash c-section was overwhelming for almost 2 weeks. My dr worked with me to assure me the most positive experience possible.

    What a sweet post championing your friend’s heart!

  21. I cannot be more pleased with this post! I am wholeheartedly supportive of our rights to have childbirth options presented honestly and without fear — I was ‘allowed’ to have a vaginal trial after my first c-section and I’m forever grateful. Not only because it all went beautifully and perfectly as I’d always dreamed, but because I know that even if it hadn’t, it wouldn’t have been for lack of trying. It wouldn’t have been at the doctor’s insistence in the face of my stubborn ‘hope.’ It wouldn’t have been because I was led to believe my body wasn’t capable. It just would have been the breaks, and I could live with that.

    I love that you tackled this topic — I’ve been wanting to talk more about it on my blog, too!

  22. ShannonL says:

    I don’t get it. Of course I believe that women should be well-informed and feel comfortable and supported by the person who is providing care. But I don’t get the “need” to have a natural birth. For my first, I was induced two weeks early because of high blood pressure. It went extremely well. For my second, we found out at the last minute that she weighed over 10 lbs and was in a breech position. There was no question that she would be delivered by C-Section, and it didn’t bother me in the least. To me, as long as the baby comes out in the safest way possible that is what is most important, not if the mother gets to live out her fantasy birth story or not. Yes, some doctors can be mean, but they are probably annoyed by moms who want to “prove themselves” by doing it the “right” way, and feel like their (expert) opinion is being ignored. I believe that the baby is Number 1, not the mother, and we should do whatever we can to keep that baby healthy while we carry it and make sure he/she enters the world in the easiest, safest way possible.
    I’m sorry, I realize that I sound insensitive. I know this affected you and it affects many other moms but I just can’t wrap my head around the thought process of at least *trying* a VBAC when you know it may not work in the first place and the doctor has advised against it. Why not just go straight to the way you know is going to work the first time and not put the baby through extra trauma? I have never had those feelings, so it’s hard for me to understand. But all people, pregnancies and births are different, so I do hope that your friend gets what she wants. It is obvioulsy important to her and we should all feel happy and comfortable with the choices made regarding the births of our children. Great topic, Christine! 😉

    • Christine says:

      I don’t think it means the same to everyone, and I think we all have a different perspective when we approach childbirth and I think that’s great. The reasons for my disappointment and need to try again are far more complex than I was able to describe in this one post. But I do want to say that I never put my child at risk. Some now argue that VBAC is safer than a repeat Cesarean. The research is always changing. I hope that’s the point I got across though – it’s really all about informing yourself and fully understanding your options, and what is safe for the mother and the child both physically and emotionally.

      Thanks for this honest comment Shannon! I definitely appreciate it.

  23. Kameron says:

    I could go off on a tirade on the topic of C-sections and how and why the rate has increased so dramatically over the last 20 years, but I’ll leave that alone. I had a midwife for both pregnancies (the same one). She was so amazing and took the time to take care of me. She addressed my thoughts, fears, and showed me that she valued my opinion. I had the most overwhelming fear of having a C-section. The thought actually caused me to have an anxiety attack. Knowing some of the factors that can (Can, not DO. I don’t want people freaking out on me here.) lead to C-section such as use of pitocin, epidurals, etc., I chose to have my children as naturally as possible. I ended up having both babies with no drugs and no tearing (even with a 9.5 pound 2nd baby) and I couldn’t have done it without my midwife. I truly believe that women need to be supported in their needs and desires when it comes to childbirth. VBACs are possible and if the OB or midwife thinks they are safe for the woman, she should be allowed to try if that’s what she wants.

  24. Sarah says:

    I get this. My son was birthed via c-section. At the time, I wasn’t disappointed at all. I wanted whatever was best and safe for him. However, next time I want to deliver VBAC. Recovering from a c-section was torture for me and my experience was akin to hell for a lot of reasons. Soon after my son was born, I had a kidney stone and someone said ‘Apparently, that is more painful than childbirth’ Here I was with a 6 wk old and had to say ‘I wouldn’t know’ It was weird for me and seemed unnatural (though, I was in exruciating pain post-surgery).

    Nonetheless, I agree. Information is key. Although, I doubt I’d choose a midwife (for a few reasons that I can’t even really articulate), I don’t question their worth. There are definite benefits to modern medicine, but women have been giving birth for thousands of years and I think it’s important to know our options and be given the opportunity to listen to our own bodies and do what feels right for us.

  25. Jenna says:

    Mmmmm–I hope to have a midwife with me as well. After watching “The Business of Being Born” I feel like my eyes were opened to the mentality doctors/hospitals can have of getting it over with as quickly and efficiently as possible, when sometimes it’s best to let the body take the longer but more natural course.

  26. becca says:

    This was such a well written and poignant post Christine. It’s a topic I don’t have a lot of passion for but I fully support your passion. I had an emergency C for my first birth and had no problem having a second C. I never craved the vaginal/natural birth as so many moms do. I FEARED the pain and only wanted my baby to be healthy so I left it at that. I do feel as if I missed out on the beauty and miracle of childbirth BUT actually getting pregnant and having two healthy babies was a miracle in itself for me. I wish your friend all the best of luck and hope the birth goes as she dreams it should.

  27. Leslie says:

    Really love this post, Christine, and the discussion it generated and memories it sparked. I couldn’t agree more with your position about choice, information, control and empowerment. I went into prenatal care with a hospital midwife, and I worried even so that I’d have to fight against the episiotomy, or even the epidural. (Around here, it’s hard to find peers and physicians who will support a woman trying to birth a baby without pain medication – and it isn’t the epidural that frustrates me, but the assumption that we won’t be able to cope without it.) But my midwife said, “I haven’t done an episiotomy in probably 15 years.” And the rest is a lovely memory of a supportive hospital staff and a comfortable stay.

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