Women want their VBACs back. You read that right. VBAC, Vaginal Birth After Cesarean is easily one of the most controversial practices in obstetrics today.
So controversial in fact, that the National Institutes of Health (NIH) hosted a Consensus Development Conference in Washington, D.C. in March. The consensus statement (here) questioning the validity of current medical thinking that “once a cesarean, always a cesarean.”
The VBAC rate peaked in 1996 at 28% and has since dropped precipitously to a lowly number of 8%. Over the duration of the conference, doctors, scientists and an array of other experts grappled with the question: “are we doing more harm than good?” Indeed, the benefits of a trial of labor (TOL), regardless of ultimate mode of birth for a low-risk woman outweigh the risks of an elective repeat cesarian delivery (ERCD). So why do 89% of low-risk women with a first time cesarean have a repeat cesarean?
On Friday, March 26th, the Triangle Birth Network co-hosted a VBAC information session at the Diapering Doula in Morrisville, NC. The event brought 25+ women and healthcare providers together in the comforting space to explore this issue with the women in our area.
Anne Hayes, the co-chair of TBN started the night off with an overview of the issue. She explained that the most common reasons stated for the dearth of VBACs in the United States are that many hospitals don’t allow VBACs at all due to their lack of immediate anesthesia availability in the case that a cesarean section becomes necessary and a fear of litigation. However, in order for a hospital to be considered mother-friendly, they are required to have a VBAC rate of at least 60%. You can read more about the mother-friendly childbirth initiative here.
However, Anne was not just touting stats. She is a living, breathing example of the redemptive power of a VBAC for a woman who wants one. Her story started with an all-too-familiar scene of a first-time mom who was told that her baby was in distress and rushed to the operating room. As it turned out, the reason for her cesarean was ruled out once the healthy, thriving baby was brought out. There were lights and strange people allowing for little bonding time between momma and babe.
The second time around she wanted things to be different.
I wanted to experience birth as nature intended. I wondered what would happen if no one messed with my body.
She attended a Jennifer Block signing of her book, Pushed, and the author encouraged her to explore the idea of a home birth. After watching the movie, The Business of Being Born and talking with friends who had had home births, she was in.
I did basically anything that I thought would prepare me for a home birth.
That she did. She listed chiropractic care, reiki, and hypnobabies as some of the preparations she made for her body, mind, and spirit. Labor day arrived, and with it a beautiful new baby, Violet.
My birth was not easy, but it is what I wanted and intended. I was the happiest woman in the entire universe. I had just climbed Mt. Everest.
Katherine Jones, another mother and a member of ICAN (International Cesarean Awareness Network) also shared her story. She describes her first birth as a cesarean a the end of a cascade of interventions. Katherine was induced because she was two weeks late. When she was 9 cm. dilated, the doctor said that she had “failure to progress” and started talking about a cesarean.
I think that I was having a full-on panic attack. The spinal [anesthesia] traveled up to my chest and I couldn’t breathe. I thought that I was going to die. My heart was broken and I was scared and overwhelmed. I knew right then that I wanted things to be different next time.
Katherine noted that breastfeeding after this experience was very healing for her. For her next birth, she planned for a VBAC with a practice who said that they would let her “try” for a VBAC. She had a successful VBAC, however her son had respiratory distress and was whisked away from her immediately. ”It sort of squashed the joy,” she said.
She exclaimed, “We were going to try again!” For her next birth she worked with Triangle OB/GYN.
“I had a great doula and a great midwife. I had the birth that I knew was possible. It shouldn’t be that complicated.”
Kandace Dole, the chair of the Triangle chapter of ICAN spoke next. She started an ICAN chapter after being trained as a doula. The area ICAN chapter will now be known as ICAN of the Triangle. The chapter currently has 70 members online and available to support women after a cesarean section. Please watch for a forthcoming updated website with meeting information. Meetings are usually held in a member’s home in order to create a private and supportive environment.
Amber Craig followed Kandace with another inspiring birth story. She had two cesarean sections, one because the baby was “too big.” Amber chose a home birth for her third child and enjoyed a lovely 3.5 hour labor!
The high after the birth is amazing! I felt like I could do anything!
Baby #4 was also welcomed at home after 2.5 hours.
The last presenters of the night were Nancy Harman, CNM and Deb O’Connell, CNM. Nancy commended the women present at the meeting by saying,
This community of women is here to remind us of what’s true.
Deb and Nancy explained that most midwives have a 5% c-section rate. Deb emphasized the midwives philosophy of care this way:
Trusting birth and being willing to be patient with birth means letting whatever is unfolding be.
Meaning, midwives are not taught to rush their clients. They are there to support, encourage, and protect the birth process, not fit it into a pre-prescribed box of how it “should” be. Their job is educating women about their choices in every situation. They expressed their confidence that “…most women who choose to pursue a VBAC will have it.” Both midwives were emphatic that if a woman is feeling led to pursue a VBAC, they should educate themselves about the benefits of home birth. If she chooses a hospital birth, their advice is to hire a doula, stay home as long as possible, and ask for a nurse who is supportive of VBAC.
Jessicca Ramirez-Tower, CNM from Triangle OB/GYN also provided valuable insight on the topic and helped to answer questions during the Q & A session. Jessicca served women as a midwife in Florida before moving to North Carolina and congratulated our state on being much more open to VBACs and birth choices in general. Go NC!
Melanie Mintzer, MD of Generations Family Practice shared her experiences practicing as an OB before the VBAC rate started dropping and her observations of the birth culture now. Dr. Mintzer has experience working in California as well as Orange County, NC. She encouraged the women present to take charge of their birth experience and advocate for their choices.
Clearly, this was a productive and inspiring meeting. Keep checking the TBN website for future informational events. Here’s to good science proving what many of us already knew: women’s bodies are wonderfully designed to birth!
