VBAC: Be Informed, Don’t Rely on Luck

This is a guest post by Sara, a BWF mama, who I asked to do a post on VBAC. She shares her story, what led to her VBAC and how it could have easily been different. Oh, and I am hardly famous, just a mom and birth advocate with a blog and Facebook page. I appreciate Sara taking the time to write for the BWF Blog. Her passion and information always shines through on our Facebook page. Thank you mama! ~Mrs. BWF

When Mrs. BWF asked me to do a Guest Blog I was thrilled. Giddy. I mean she’s practically famous and she reaches thousands of people. Several THOUSANDS! Maybe I’m in over my head? Maybe I should’ve politely declined? But she asked me to write about VBAC. And my passion for that won out over the potential for an epic embarrassment in front of thousands of people, so here goes:

I still get teary eyed and a little angry when I think about how lucky I was to have my VBAC…

I had a cesarean section with my first baby. She was a footling breech. That was years before the internet, BWF, or Google. Back when research meant the Library & the Dewey Decimal System. Back when I didn’t know what I now do. Back then, I was a Typical American Woman and did not know my options.

I moved to a new city, and ended up by sheer luck with a midwife for my routine womanly care. She worked with the OB/GYN I just happened to pick of my insurance’s list of in network physicians. When I called, they set my appointment up with her. Back then, I knew nothing about midwives. OK, that’s not entirely true, but I thought they were extinct; made obsolete by OBs and modern medicine.

In 2005, when I got pregnant with my 2nd child, I called to make an appointment with the OB. You know, because I was having a baby. Midwives do routine care, but surely being pregnant meant I would now see the OB. Imagine my surprise when a midwife walked into the exam room instead. She explained all about midwives and that she could care for me or transfer me to the OB, it was up to me.  I knew her, felt comfortable with her. I actually loved her and felt a connection to her. I chose her.

She asked me if I was considering a VBAC. I was almost too embarrassed to tell her I didn’t know what that meant. She explained to me what it was, the option of ERCS, and the risk of uterine rupture. She gave me information and encouraged me to read Ina May Gaskin’s “Guide to Natural Childbirth” & Henci Goer’s “Thinking Woman’s Guide to a Better Birth.”

At the time, I was in college and taking a research class. I had to do a semester-long research project on a self-selected topic—how’s that for timing? I chose VBAC compared to a repeat cesarean section. I had access to the research database and Library of that college and another local University they partnered with. I made the most of it and spent hundreds of hours poring over studies & reviews. The paper earned me an A and I decided to choose VBAC.

At 36 weeks, there was concern about baby’s growth, so a Level 2 ultrasound was done. The perinatologist said he was growing fine. He also told my midwife that my baby’s head was too big, that no one “my size” (I am a TINY gal) could vaginally deliver a baby with such a large head. He used the terms “cephalopelvic disproportion,” “obstructed labor,” and “uterine rupture,” and guaranteed, yes his exact words, that I would need a c-section. His medical recommendation was that one be scheduled at 39 weeks. Midwife added this information to my chart, but it did not change her support of my VBAC or cause her to transfer my care to an OB for a c-section.

After 8 hours of labor, most of it at home, and 52 minutes of pushing, I vaginally delivered my son, 6lbs 14 oz with a 14 ½” head. I was so proud of myself. In those first moments, I thought about how lucky I was to have found her, my Midwife, my Champion. Without her, those first few moments would have almost certainly been different; much, much different.

• If I had not made an appointment with a midwife for routine care, I probably would not have seen one for my pregnancy and likely would not have encountered such support for VBAC.
• Had my midwife not been in a practice, one of a very few in my area, that was supportive of VBAC’s, I likely would have been transferred to the care of the OB for an ERCS.
• If she (or my OB) blindly listened to the specialist in fetal medicine, I would have certainly had an unnecessary c-section.
• Had she not trusted the process of birth, I wouldn’t have learned to myself.
• If my midwife did not educated me and encouraged me to practice my right to informed consent, I wouldn’t have ever known I could or thought to refuse the things that would have reduced my chances of having an intervention free, un-medicated successful VBAC.
• Had I lived 30 miles farther in any direction, I would have never known about the benefits and safety record of VBAC. Not only would I not have had VBAC as an option, I likely wouldn’t have even known my options were being limited (and THAT is the part that really gets me…).

**This is not speculation. This is based on the practices of the OBs and hospitals in my area at that time.**
In the end, I got a VBAC because I was lucky enough to be in an area and with a provider that not only “allowed” VBAC but encouraged it. Because I was lucky enough to end up with a provider that practiced Scientific, Evidence Based Medicine instead of Standards Based or Defensive Medicine and encouraged me to inform myself. Because I was lucky enough to live near a hospital that “allowed” VBACs.  Because I was lucky enough to get a provider that believed in not only Birth but Autonomy in making Health Care decisions.

I feel eternally grateful to my midwife for the powerful impact she had on me as a woman, my births, and my baby’s first moments Earthside. I feel blessed beyond words. I feel lucky. I also feel sad and more than a little angry on behalf of all the “unlucky” Moms.  What the hell has our system come to when the choices available to women are based on LUCK, circumstance or the area you live in more than research, science, medicine (when applicable), and Mama’s decision based on informed consent/refusal? There are not enough words to accurately describe how WRONG I feel this is or how hard I am willing to fight to fix it.

I was lucky to have my VBAC, but I shouldn’t have been. And it’s tragic that I was…

**I am a passionate advocate for autonomy in making healthcare decisions, the process and right of Informed consent/refusal and for reform of the process as it is in practice today. When medical professionals violate, disregard or make light of the process, they actively and knowingly violate the Code of Ethics for their profession and the law in all 50 States. Don’t want to leave your medical decisions up to luck? KNOW your rights, the laws and what Informed Consent/Refusal is SUPPOSED to look like. For your rights and the laws visit here. For the AMA definition/expectation of Informed Consent/Refusal visit here.  You have a RIGHT to know ALL the risks and information with ALL of your choices—not just the ones the care provider prefers. Your care provider has both an ETHICAL and LEGAL obligation to ensure that you do.**