This week we are thrilled to feature Desirre Andrews (midwife assistant & ICAN President) of Preparing for Birth as she discusses how to say no to interventions after a previous experience with cesarean birth.
Let me begin by saying I am a VBAC and Cesarean mother of 4 boys. Officially I am designated as a 2VBA2C mother. I too, have walked this path out just like countless other women. Many VBAC hopeful mothers are in a club they did not ask to be a part of regardless of why or how the cesarean occurred. The first or last birth leaves not only a uterine scar but different possibilities for any subsequent future pregnancy and birth. It can be a very sobering, shocking, even overwhelming realization that there may never be a vaginal birth in the future or again. The option at birthing versus repeat surgical delivery can be determined by accessibility and cultural expectations, needs and desires.
Why would there be an issue of VBAC access by hospitals and providers? VBAC is not a procedure that requires specific training or skill, unlike surgery. In a nutshell, it is the usual extension of pregnancy and labor to push out a baby vaginally. In essence, it IS the biological norm and expectation. The uterus does have incredible resiliency in healing, like other muscles in the human body. It is also widely recognized by and large to be a safe, reasonable option for women and babies by the National Institute of Health (NIH) and the American College of Obstetricians and Gynecologists (ACOG) as evidenced in 2010 statements all backed up by years of evidence.
Some issues in access availability are language in the previous practice guideline statements stating immediately available anesthesia is needed (this idea knocks out vast number of rural facilities from offering access), physician liability concerns (cost of liability insurance, thought of being sued), lack of true informed consent between mother and physician comparing repeat surgical risk and VBAC risk, physician fear and desire for making labor and birth a zero risk venture (life is not risk free, either is labor and birth and can never be), and overall physician/hospital culture (what pressures, protocols and practices are widespread in an area).
Yes even with all of these, some changes are being made toward more access, albeit very slowly in most area. Women are compelling providers and hospitals to offer access through determination, evidence, self-advocacy, exercising options, rights and open communication. It is possible. Another point to look at is women are more and more choosing alternate places to birth whether at free standing birth center or in the privacy of their own home (with a midwife or unattended) when access is declined in the hospital environment. Women are increasingly saying no to those who refuse to give options and choice.
The culture in which a childbearing woman lives (family, friends, co-workers, faith community) affects decision making for the positive or negative. When some or all of those in these cultural areas are supportive of VBAC, she is more likely to choose going for it. When it is the opposite and she is told to just do the “easy” thing (for whom, surely not the one undergoing surgery), ask “Why would you WANT to labor? How lucky you are to be able to get out of it.” or “What does it matter anyway? All you want is an EXPERIENCE, A healthy baby is all that matter anyway….” All of these negate the woman herself. It is more than okay to want the vaginal birth. It is good to look at what is the healthiest birth avenue. That goes a long way to seeing how the best experience is also the healthiest experience for both mom and baby.
I asked a recent VBAC mother, Katie Z. how her culture affected her decision to go for a VBAC. She stated “Friends and family were extremely supportive, especially after seeing what I went through with (my) cesarean and subsequent PTSD. The community (at large) most was surprised it was no longer once a cesarean, always a cesarean.”
She was able to more readily and easily pursue the desire and need to have a healthier experience because she was fully supported by those in her life. Conversely, some women are willing to buck the trend within their culture and have a VBAC. With lack of support, fear mongering and too often misguided advisement, it is much more a challenge to gestate peacefully and prepare for birth. It is possible, but much more difficult when those a woman cares most about are not be in her corner. I will share that with my fourth son; very few in my world shared my point of view. Thankfully my husband and certified nurse-midwife did. That was really all I needed. Frankly, it can be a dangerous thing to tell a determined woman “no”. She is very likely going to find a way.
Bottom line, there are options though to exercise them it may require much effort, research, relocation, financial planning, meeting with administrators, changing providers and more.
Desirre Andrews, CCCE, LCCE, CLD, CLE, Midwife Assistant & ICAN President. Preparing For Birth, LLC – http://www.prepforbirth.com.