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.