Journey Towards a VBA2C

Living in the quiet, quaint town of Soldotna, Alaska, one woman is preparing for the birth of her baby girl, who is due this Valentine's Day. But this birth is a little different from most. Samantha Van Vleet is planning for a vaginal birth after two cesareans, or VBA2C. This is a feat being undertaken by more and more women, who are realizing that the old saying, "Once a c-section, always a c-section" is not true. In addition, Samantha also has to deal with delivering in a hospital that has a ban on VBAMCs (vaginal births after multiple cesareans), and has to travel five hours away so she can see a doctor who supports her decision to go against the hospital ban and have a VBAC.

Background

Samantha, 22, is a birth doula and childbirth educator. She has two children. Madison is three years old and Danny is two. Both were delivered by c-section. Her birth with Madison is typical of many other women who've had c-sections. After going a week overdue, her doctor insisted that it was dangerous for her to go past her due date and that she would need to be induced. "When he offered the induction, I took it. I didn't know that it would end up in a cesarean, or that it was even likely that it would. At that point, I was given the impression that induction wasn't a big deal," says Samantha.

With Daniel, Samantha wanted to go for a VBAC. After a non stress test when she was a week and 4 days over her due date, she was sent to be induced, even though she was already going through prodromal labor. She had a feeling it wasn't going to turn out right. "I should have listened to my gut," she says now, "I ended up with a cesarean due to fetal distress."

More and more women are having c-sections these days, and the numbers are rising. According to the International Cesarean Awareness Network (ICAN), the cesarean rate for 2009 is at an all-time high, 32.9%. This rate is alarming, and ICAN President Desiree Andrews says, "Every woman in her childbearing years MUST sit up and take notice of this alarming and astonishing rate of surgical delivery."

Why a VBAC?

There are many reasons Samantha wants this birth to be a VBAC. First off, there is the traumatizing experience of her first two c-sections. She calls the experience of having an unnecessary c-section "birth rape", a term used by many women to describe the experience of having your baby taken from your body needlessly and essentially without your consent. "It's a hard subject to describe, considering how controversial the subject of 'birth rape' is, but that's how I felt," she explains, "I have been the victim of 'real' rape, and of 'birth rape'. Out of the two, I feel that the healing, coping and recovery from the sexual rape was easier and less painful than the recovery from my 'birth rape'. It's hard to recover from an event, such as a traumatic birth, when that day is the worst day of your life, but the best day of your life (due to your child's birth) at the same time. It's conflicting and confusing."

Then there was the physical and mental pain she felt after the c-sections. Besides the usual pain, swelling, and numbness at the incision site, she experienced a few more things. With her first birth, she suffered from postpartum depression, which turned into postpartum psychosis. The postpartum psychosis led to problems bonding with her baby, problems in her marriage, and ultimately almost cost her her life. She believes that her traumatic birth experience led to her postpartum psychosis. With her son's birth, she experienced several surgical complications, including a pelvic infection and the incision opening up a few weeks after her c-section.

Another reason she wants to have a VBAC is that she plans on having more kids in the future. "I don't know how many children I want. But I do know that I don't want to be limited by the number of cesareans it's considered 'safe' to have."

A Tough Road

Samantha has to go through a lot to be able to deliver this baby vaginally. When she found out she was pregnant, she went to see her regular doctor. But after mentioning her plans for a VBAC, her doctor was very unsupportive. She never went back. Through recommendations on several natural parenting and doula websites, she found Dr. Glen Elrod. She sent him an email explaining her situation and asking about his views on various issues like induction and expectant management of labor. Dr. Elrod replied back in a long and thoughtful email. He fully supported Samantha's decision to have a VBAC, despite the fact that the hospital she will be delivered at bans vaginal births after multiple cesareans. Right away she was sure she wanted him to be her health care provider during her pregnancy.

However, in order to see him, she has to travel five hours away to the city of Wasilla for her monthly appointments. The hospital she is delivering at, Mat-Su Regional Hospital, is also 5 hours away. In order to be there in time for the birth, she is renting a hotel suite close to the hospital a week before her due date. It's expensive, but she feels the expense is necessary. "I'd rather spend the money and know I did my best, than not and always wonder 'what if...'"

If Samantha goes into labor before her planned stay in Wasilla, she will do one of two things depending on how far along in her labor she is. She will either have a friend drive her the five hours to the hospital (there are three hospitals en route if labor takes an unexpected turn) or she will deliver her baby at home. She says she's scared of having to deliver at home, but she'd rather do that than go to her local hospital where she knows she'll be pressured into another c-section. "I don't feel that in labor I'd be strong enough, or in the state of mind, to refuse and fight tooth and nail against it."

She's also dealing with a hospital ban on vaginal births after multiple cesareans. In fact, there is no hospital in the State of Alaska which allows vaginal births after multiple cesareans. This is frustrating to Samantha and many other women who want a VBAC, especially since it is now known that vaginal births after multiple c-sections are safe. According to the Guide to Effective Care in Pregnancy and Childbirth: "The available data on outcomes after a trial of labour in women who have had more than one previous caesarean section show that the overall vaginal delivery rate is little different from that seen in women who have had only one previous caesarean section." Also, the American College of Obstetrics and Gynecology has revised its guidelines for the safety of vaginal births after multiple cesareans.

Samantha isn't too concerned about the hospital ban. Her doctor has reassured her that he will provide her with the best care he can, regardless of whether she consents to a cesarean or attempts a vaginal birth. And she knows the hospital cannot force her to have a c-section against her will.

Samantha's husband, Daniel, has been very supportive during this whole process. "He has always told me, from the very beginning, to do what I feel is best and make the choices that I know I can live with." Others have not been so supportive, one woman going so far as to say that Samantha was killing her baby by going for a VBAC. In fact, VBACs are a very safe procedure. According to the book Ina May's Guide to Childbirth, by Ina May Gaskin, a woman having a repeat cesarean has three times the chance of dying and five to ten times the risk of injury. Also, according to a 2006 study, "Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62)."

What's Ahead

Samantha is preparing for a VBAC as best as she can. She has been very active during this pregnancy. She is also seeing a chiropractor, which has helped the baby move into a more favorable position for vaginal delivery. She is also drinking red raspberry leaf tea, which helps tone the uterus and which some believe helps strengthen c-section scars, and is taking evening primrose oil to help ripen her cervix for labor.

If Samantha ends up with another c-section, she thinks she will be ok with it. "I have faith in Dr. Elrod that a cesarean will not be resorted to unless it truly is absolutely necessary." She also takes comfort in knowing that she has done all she can do to ensure she has a vaginal birth. Some have suggested to her that she is wasting her time and money preparing for a VBAC that may end in a c-section. To this, she says, "I will regret not trying, more than I'll regret having 'wasted' the money."

How Samantha's birth turns out is yet to be seen. She feels confident that she'll be able to do it, and trusts in her doctor. "I've done everything I can do, and now, I'm waiting. I believe I'm capable and I believe I can, but I also know that there is never a 100% guarantee on anything."

Being able to have a VBAC would mean the world to Samantha. It will go a long way toward helping her heal a little from her experiences with her first two births. "To my doctors, I was an inconvenience and a slow laborer. There wasn't anything truly wrong. I think achieving a vaginal birth might help me to heal from the hurt I experienced as a result of that coercion." And after hearing so much criticism and negativity from family and friends, she wants to prove to people that she can do it. "Actually succeeding would be amazing," she says. "Something I'd want to shout from the rooftops."

If you are interested in how Samantha's birth turns out, check back often as a follow up story will be posted sometime in February or March.

To read about going overdue and inductions, check out this article by Samantha Van Vleet.

To read about the concept of birth rape, check out this article by Samantha Van Vleet.

To read about the experience of an unwanted c-section, as well as some tips to deal with the emotional pain, check out this article by Vanessa Bartlemus.

For some tips for having a successful VBAC, check out this article by Vanessa Bartlemus.

References:

Childbirth: Vaginal Birth after Cesarean FAQ

International Cesarean Awareness Network: Cesarean Rate Jumps Again To Record High

Hippie Dippie Bebe: Risk of VBAC and Repeat C-section

VBAC Facts: Primary Elective Cesarean Increases Infant Mortality 2.9 Times