As Parent Proof’s tens of loyal readers may recall from my riveting birth story, my first child was born via emergency C-section due to extreme decelerations of his heart rate during a slow-to-progress labor. After I was stitched up and stapled shut and drugged out and returned to my postpartum room to groggily process the both prolonged and sudden arrival of my son, I had two successive thoughts: 1) What the F just happened? And, 2) I’m pretty sure I never want to do that again.
So began my journey to the birth of my second child via VBAC, which stands for “vaginal birth after Cesarian.” VBAC is one of the many topics that has swung on the pendulum of pregnancy advice from one extreme to the other and back again over the past three decades, and thus the mere mention of a VBAC gives total strangers the right to maintain very strong opinions about your uterus.
The primary controversy surrounding a VBAC is that it carries a small risk (about 1% according to the NIH) (and here is the actual NIH publication in case you are super thorough like that) that the uterus will tear along the previous C-section scar during labor or delivery, putting the mother at risk for serious blood loss and the baby at risk for heading out the wrong exit and suffering from oxygen deprivation and even death (risk of death is <0.5%). It all sounds pretty cataclysmic, thus raising the question as to why any woman would bother just for the sake of a vaginal birth that will probably result in a lifetime of peeing herself a little bit every time she sneezes. It turns out that a pregnant woman has at least a 1% chance of encountering any serious complication associated with childbirth. Having a baby is a dangerous business, but a catastrophic uterine tear that results in harm to the baby is one of the least likely selections in the grab-bag of scary shit that can go wrong. Major complications during a planned repeat C-section are also rare, and in my opinion, a woman should have a VBAC if she wants one, and she should have a repeat C-section if she wants one, and the Shrill Harpies of the Internet should keep the focus on their own vaginas and worry less about everyone else’s.
The NIH data on VBACs cited above is relatively new, and the medical profession is second only to the Republican party in the speed with which it adapts to updated scientific information, thus for those of us who want a VBAC, it can still be a bit of an uphill battle. I did my research and studied all of the advice Google had to offer, yet in the end I basically did everything wrong and managed to have a successful VBAC anyway. Just in case someone else out there is interested in having a VBAC but is also too lazy to be truly proactive about it, I thought I would share all of the ways you can screw things up and still end up pushing a baby out of your vagina like you’ve always dreamed.
Tips for Having a VBAC that I Totally Ignored And Still Had a VBAC
- Find a Supportive Healthcare Provider: I was at my 6-week postpartum appointment after my C-section when I first mentioned to my OB that I might want to try for a VBAC if I ever got pregnant again. Her initial response was: “There’s no easy way to get a baby out. You either ruin your vagina or you ruin your belly, and you’ve already ruined your belly.” I’m surprised they don’t have that embroidered on a pillow in the waiting room. Given the internet’s absolute insistence that I find a pro-VBAC provider regardless of whether that person is a physician or a large animal vet, I should probably have spent the early weeks of my second pregnancy interviewing new doctors. However, I felt like my obsession with having a VBAC needed some counter-balance from someone whose primary interest was not so much in fulfilling my notions of maternal empowerment but rather in getting me and my child through humankind’s most arduous natural transition as safely as possible, so I stuck with my OB despite her penchant for describing childbirth like a scene from a George RR Martin series.
- Choose a VBAC-Friendly Hospital or Birth Center: The hospital where I delivered both babies (and where my brothers and I were born) has about a 33% C-section rate, so it probably wouldn’t fit ICAN’s criteria for “VBAC-friendly.” However, given my love for in-room food delivery and hydrocodone, there was no way I was having this baby at home, and the most popular midwife group in my area only has privileges at a local medical center known primarily for its willingness to overlook mandatory reporting for gun-shot wounds, so once again I decided to go with the devil I knew.
Hire a Doula: Extreme pain makes me act like a rabid wolverine caught in a bear trap—there is no amount of money I could pay a stranger to put up with that.
Have an Unmedicated Birth: I’m pretty sure I would be divorced and in prison if I had attempted an unmedicated birth. My doctor told me that she strongly preferred that I get the epidural in case I did have a uterine tear and needed to get to surgery immediately, and I was all, "don’t throw me in that briar patch, how soon can I get the needle?" My labors are long and my uterus has a flare for the dramatic—it likes to act like it’s going to expel the baby on the bathroom floor from the first contraction, while my cervix forgets to set its alarm and oversleeps the whole affair by 10 to 12 hours. By the time I get to 4 centimeters, I’m ready for a cocktail, as is everyone else on the L&D floor.
- Deliver by Your Due Date: This seemed like a no-brainer. My son was born 9 days early, surely all future babies would follow suit. But my daughter, due on December 25th, did not want to compete with Santa and Jesus for her entire childhood, nor did she feel that she should be in any big hurry just for a single extra tax deduction given the years of being a financial suck she has ahead of her, and so she took her time, arriving on January 4th, a mere 10 days past the VBAC deadline. But it turns out my super medical-model doctor wasn’t a complete head-case about a late-term baby, or maybe she was just moved by my strength and resolve and also by the fact that she was on vacation from Christmas to New Year’s. Whatever the reason, baby girl made her way into the world in her own time, in just the way she was always meant to.
In truth, while neither my OB practice nor hospital are public cheerleaders for VBACs, both ended up being supportive of my birth plan, which made a huge difference once labor had actually started, particularly at the point when I was attempting to book an OR by myself because I was tired of this “contraction” crap.
The only thing I did on my own that I believe made a difference this time around was read Ina May’s Guide to Childbirth by Ina May Gaskin. I read it twice, once in the first trimester and once in the third, and I even took a few notes. Despite having zero interest in having an orgasmic natural birth on a farm, the book still helped me prepare for the pain of labor and develop a few techniques that allowed me to physically and emotionally relax more than I was able to during my first birth experience. Overall I felt more prepared and less anxious, and I believe that made a huge difference in my body’s ability to do what it needed to do.
In the end, having enjoyed both types of delivery, I can honestly say that my doctor was right: there’s no easy way to have a baby. The C-section was harder in some ways, the VBAC was harder in others, and each gave me a beautiful, healthy child to embarrass with his and her own unique birth story for many years to come. Now excuse me while I go grab a Poise pad before I sneeze.
Written by: Kathleen