VBAC: {Erin’s Story}

I met Erin through my midwife, Harmony Miller. Besides being an awesome wife and mommy to 3 children, Erin Ernst is the Chapter Leader of her local International Cesarean Awareness Network chapter, ICAN of Sarasota. This ICAN chapter holds monthly meetings with different topics and/or speakers at each meeting, as well as monthly Birth Story Circles for women to share their journeys with each other. They also have an active Facebook page for discussions.

Erin is also an extremely talented artist (click HERE to see her artwork)

Today she is sharing her story with us and what it is like to have a VBAC (Vaginal Birth After Cesarean).

 

VBAC: {Erin’s Story}

The term VBAC (Vaginal Birth After Cesarean, pronounced “vee-back”) was one that I was familiar with, due to the many birth books I read throughout my first pregnancy. However, it was never something I really gave much thought to, as I had planned a natural birth.

When I really felt the implications of “VBAC” though, was when the nurse was checking on me after the delivery of my first daughter. I was in shock by what had just taken place when she cheerfully said while taking my vitals, “Now you can just schedule your future babies like you do your hair appointments!” I wasn’t quite sure how to respond, but mumbled something about not wanting to ever go through that experience again. She looked a little puzzled and then said, “Well, I think there’s one doctor here who does VBACs.”

[pullquote_right]For the first time, I realized that the cesarean that I’d just had, not only affected my first child, but would shape the births of my future babies as well…[/pullquote_right]For the first time, I realized that the cesarean that I’d just had, not only affected my first child, but would shape the births of my future babies as well – babies that I hadn’t even thought about yet! It took a while to wrap my head around this. I was still trying to figure out how I ended up in the hospital, and now recovering from major abdominal surgery, after envisioning nothing but a beautiful water birth for the last 9 months.

The day I’d gone into labor, 5 days after my due date, was an exciting one. I spent the afternoon in early labor, timing contractions, and too excited to eat. My husband and I rushed to meet our midwife at the birthing home late that evening, sure that our daughter would be arriving very shortly. She checked me, told me it was still early, and suggested I go home to rest. I couldn’t fathom another 30 minute car ride, so we decided to stay. I labored all night, the next day, and into the next evening. I had no appetite and wasn’t able to keep much down, so I was becoming exhausted. After having my water broken for some time, and not progressing past 8 cm, we made the decision to transfer to the local hospital. We were planning on getting an epidural so I could rest until it became time to push, and pitocin to give my contractions more power. After arriving early that Sunday morning, and getting checked in, the nurse informed me that the on-call doctor (who I hadn’t even met yet), told them to prep me for a cesarean. I laughed in my sleep-deprived state, knowing this was ridiculous. My baby and I were perfectly fine. I was only tired. Eventually, I met this OB. We spent a good 5 hours or so butting heads. I was refusing what I felt would be an unnecessary cesarean, and begging to just try the epidural and pitocin that we had come there for, but he refused me that option.  After asking for a second opinion, he came back in the room and offered to “compromise” by doing an ultrasound to see if the baby was “too big.” I thought that was fair enough at this point. My husband and I were both well over 9 lbs at birth, and I expected our child to be of similar weight.  My idea of “too big” at this time would have been 11 or 12 lbs, and I was sure that the child in my belly was not that large. The ultrasound tech came and found our daughter to be only 8 lbs, 14 oz.  We celebrated as we waited for the doctor to come back into the room.  His opinion was different from ours though, as he called this weight “macrosomic.” He told me I had “failed to progress” and that I would never fully dilate if I hadn’t by now, and that even if I did, there was no way I could push out this giant child.  He offered that even if I did manage to do so, with the aid of Pitocin, that I would surely cause the child brain damage or even death.  [pullquote_left]I felt in my heart that he was wrong, but didn’t see any other options, so I gave in to a cesarean birth. [/pullquote_left]I felt in my heart that he was wrong, but didn’t see any other options, so I gave in to a cesarean birth. Our daughter was delivered within the hour. She was long and skinny, at 8 lbs 14 oz, and 22” long. She and I were separated immediately after birth. She went to the nursery with my husband, and I went to a recovery room with a nurse. We were reunited an hour or so later – what seemed like the longest hour of my life.

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Shortly after the birth of my first daughter, my midwife referred me to the local chapter of ICAN (International Cesarean Awareness Network).  Through this group, I met women who had been through similar experiences as myself, as well as women who had gone on to have VBACs.  I also learned how the attitude surrounding cesareans and VBACs had changed over the years.

Three years after my daughter’s birth, I finally felt ready to become pregnant again.  I found out everything I could about ways to increase my chance of a VBAC.  It seems that the big “fear” surrounding VBAC is the chance of uterine rupture, but that honestly wasn’t a fear of mine.  The chance of rupture in a labor that is progressing naturally is less than 1%.  That makes it much safer than an amniocentesis, which is a routine test, often encouraged by doctors.  My personal biggest fear going into this was having the same thing happen as with my first labor… not progressing, transferring to the hospital, and having a cesarean.  Because of this, I put a lot of time and effort into moving past, and healing from, my first birth experience.  Knowing that statistically, the overall success rate of attempted VBACs is 60-80% was encouraging, considering that the vaginal births for ALL women at our local hospital was less than that. For my second pregnancy, I chose to go back to the wonderful midwife who I had spent my first pregnancy with.  Because I had a previous cesarean, my “risk score” was higher, making it necessary to get a “sign off” from an OB for my midwife to be able to take me on as a client. Any OB can do this sign off, so I went to the seemingly “most VBAC friendly” local OB at the time, bringing along my medical records from my previous labor and surgery. Overall, the experience was uneventful. He gave me the basic pros and cons of VBAC vs. cesarean to consider. He suggested that if I only was planning to have 1 or 2 more children, that cesarean was the way to go, but if I planned on having many more kids, than VBAC was the safer route (because the risks of cesarean greatly increase with each one you have).  After looking at my records and my labor pattern from my previous birth, he told me I had a “50% success rate.” He also mentioned that it’s better to attempt a VBAC if you’ve been double sutured, as opposed to the single layer uterine closure that I had, as it lessens the risk of uterine rupture. When I asked him why the double layer closure wasn’t standard, he told me that it takes longer to do and also increases the chance of infections and complications during healing, so the single sutures are most common these days. He then gave me his opinion that all VBACs should be attempted only in hospitals, asked me if I had any questions, and then signed off on my paper, saying he’d explained the risks and benefits to me. My second pregnancy went along as smoothly as my first did, and I surprised myself by going into labor a day before my due date this time.  My water broke first, which really took me off guard, and contractions didn’t really get going for another 8 hours, after some acupressure. The nice thing was that it gave me a chance to eat a nice big breakfast this time, knowing I’d need my energy in the near future. I did have a brief moment of panic over my membranes having ruptured but no contractions, knowing that I was now “on the clock” and would need to have the baby within 24 hours or transfer to the hospital. My midwife was very calm, positive, and reassuring though.  When labor did begin it was steady and very by the book. Things got more intense pretty quickly, and I found relief in the big birthing tub that was inflated in my own bathroom. I decided not to have my cervical dilation checked at all during this labor, knowing that it doesn’t mean a whole lot, and also that I’d be really disappointed to hear I wasn’t as far along as I’d thought, or that I wasn’t progressing as quickly as I’d hoped.  Things moved right along though, and I was soon feeling “pushy.” I pushed for a while in the tub, able to move into different positions, and having my husband behind me for support. Soon [pullquote_right]our second daughter was born into our arms, right there in the water,[/pullquote_right]our second daughter was born into our arms, right there in the water, with her big sister watching pool-side, just 8 hours after contractions had begun. It was such an amazing experience, and just how I’d imagined it would be. We had our second daughter – a healthy baby girl, 8 lbs 6 oz, and 21” long.

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When our daughter was 18 mos old, I became pregnant with our third child.  Another easy pregnancy, and this time, we found out we would be having a son. Once again, we planned a home birth with our dear friend and midwife. The “VBAC pressure” wasn’t there this time. I had done this already, and was pretty confident in my body’s ability to do it again. There was also no need to get another sign-off, since I had gotten one for the previous birth. I went into labor just a few days after my due date. I started having mild contractions in the wee hours of the morning. After about an hour of this, my water broke, and things started feeling more intense. I had my hubby set up and fill the birthing tub, and got in as soon as I could. I could tell things were moving along quicker, and soon I was feeling the need to push. I didn’t push for long, though I definitely felt like I was pushing harder than I had with the last birth. In less than 4 hours from the first contractions, I was sitting in the birth pool holding my son. His dad was in the water next to me, and his two big sisters were thrilled – touching him and watching him from the outside of the tub.  Their baby brother was the biggest of them all, at 10 lbs 7 oz, and 23” long. I could tell he was a little bigger, but was really shocked when he was weighed! I also couldn’t believe that I had birthed such a large baby without even tearing (I hadn’t torn with my last birth either), and my recovery after this last baby was the easiest by far.

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When you are doing everything you can to have your natural birth, let go. Try not to worry.  Trust your body and know that what is meant to happen will happen.

For anyone who has had a cesarean birth, my number one tip is to find other women who have gone through the same to talk to – whether it be an online community or in person.  Nothing compares to someone who knows the emotions you may be experiencing when you need support.

Erin’s 8 Tips For Avoiding a C-Section:

  1. Avoid induction or labor augmentation. If you and your baby really aren’t ready, an induced labor may not progress as quickly as expected.   An induction of labor that is not medically indicated is associated with a 67% increased risk of cesarean, compared with a spontaneous labor. The contractions caused by Pitocin are often stronger and longer than they would naturally be, and thus can cause fetal distress.
  2. If you are birthing at the hospital, stay home as long as possible. Once in the hospital, you are expected to move along quickly.
  3. Don’t let your provider break your bag of waters too soon (or at all). This puts you “on the clock” and they will want the baby delivered within 24 hours to avoid infection. Doing this can also cause the baby to get “stuck” in a bad position, which can stall labor and make pushing more difficult, and at the worst, breaking the water before the baby’s head is engaged can cause cord prolapse, which is cause for an emergency situation.
  4. Skip the epidural. Epidurals can interfere with your body’s natural hormones which may slow labor and increase your need for Pitocin. They can also cause a drop in the mother’s blood pressure, which reduces the blood flow to baby, affecting baby’s heart rate. Having an epidural can also make it hard to move around in different positions that may be necessary to push your baby out, as well as numbing the mother’s pelvic floor muscles, making pushing difficult or ineffective.
  5. Use a doula. Women who have a doula for continuous labor support are 50% less likely to have a cesarean.
  6. Eat during labor. Know that your body will be doing a lot of hard work, so plan to eat early in labor to keep your energy up, and snack and hydrate as often as you can.
  7. Get baby in a good position to birth. Especially toward the end of your pregnancy, avoid lying in recliners and other reclining positions, which can cause baby to flip over and become posterior., which is a much more difficult position to birth vaginally. It is best to relax in forward lying positions, as if your belly is a hammock for baby to lie in. Also, doing pelvic rocks on hands and knees is helpful.
  8. Keep baby in a good position. Stay active during labor. Move around, walk, dance, rock in rocker, bounce on a birthing ball, and do your best to avoid lying on your back.

 

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Birthing From Within

PURCHASE

VBAC Facts:

  • In the early 1900’s, cesarean’s were very rare and saved for true, life-threatening emergencies. At this time, “once a cesarean, always a cesarean” was the dictum, so the risky procedure was avoided if at all possible. As technology improved and cesarean’s became safer, they were used more frequently. Still, in 1970, the cesarean rate was only 5%. The cesarean rate continued to rise in the 70’s and 80’s, replacing other risky procedures such as forceps use. By 1985, the cesarean rate had risen to over 22%. At this point, people realized that changes needed to be made, so VBACs were looked into, and found to be a safe choice that would help to reduce the cesarean rate.  ICAN was born in 1982, and helped to promote VBAC.  By the mid-90’s VBAC was the norm.

 

  • Unfortunately, also in the 90’s came in increase in induced labors, including induced VBAC labors. This also included the use of Cytotec, a drug that isn’t even approved for labor induction, but was/is commonly used for just that. When a VBAC labor is induced, the usual low chance of uterine rupture is greatly increased. Instead of blaming inductions though, it became the VBAC that was said to be “unsafe.”

 

  • In 1999, ACOG ( American College of Obstetricians and Gynecologists) released new guidelines for attending VBACs, requiring doctors and anesthesiologists to be “immediately available” during labor.  Because of this and fear of lawsuits, malpractice insurance made it more difficult for doctors who attended VBACs to be covered. Some doctors and even hospitals have refused to do them.

 

  • Cesarean rates have been steadily climbing since then, with a national rate of 33% in 2011, with some states and hospitals being much higher. WHO (World Health Organization) has found that “the best outcomes for women and babies appear to occur with cesarean section rates of 5%-10%. Rates above 15% seem to do more harm than good.”

 

  • Needless to say, cesarean rates have gotten too high, and something must be done. ACOG has even taken note, as they released a new set of guidelines this past year, regarding VBACs.  As with their past recommendations, they still say that most women with one previous cesarean delivery with a low-transverse incision are candidates for TOLAC (Trial Of Labor After Cesarean), but now they they include women with two previous cesareans, as well as women carrying twins.

 

  •  It hasn’t become the standard yet, but it does seem that there are more OBs providing VBACs these days than there were when I had my first child. I think the more request there is, the more available they will become.  We just need to keep demanding them!  Know your rights. You have the right to refuse any medical procedure, from induction to repeat cesarean. There is no law anywhere against VBAC. It is also perfectly legal to birth twins and breech babies vaginally. Find a provider that truly supports and respects you and your choices, and a birth environment that you feel most comfortable in. Be informed.

 

  • The primary cesarean rate is still very high still. We must also do what we can to get these numbers down. Reducing unnecessary cesareans will reduce the need for VBACs. Cesareans can be wonderful, life saving procedures when necessary, but are certainly overused these days. There are certain medical interventions and medications that, when used without true need, can increase your risk of cesarean. No matter how great your plans are, cesareans can not always be avoided. There are things we can do though, to lessen the chances of having a them. Here are a few of those things:

 

 

 

Click {HERE} to read our interview with Laura Gilkey on America’s Maternal Health Care Crisis

For more Birth Stories, click {HERE}

***Feature image courtesy of Jessica Adkins Photography***

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