My VBAC Attempt: What I Learned

Remember when I posted Xander’s birth story and promised a follow up with what I learned?  Yeah, I didn’t forget, I just have so much to say and honestly didn’t really know where to start.

Before I had Jack, I had heard the term VBAC a few times and knew what it  meant, but my knowledge really stopped there.  I didn’t know that the c-section rate in the US is around 30%.  I didn’t know that there are hospitals that either flat out ban VBACs or have a de facto ban on VBACs.  I didn’t know that there were hospitals and doctors out there that put conditions on VBACs that make it essentially impossible to have one.  I’m one of the fortuante ones. I didn’t have to deal with any of the craziness that surrounds the access to VBACs.  Some of it was luck but some of it wasn’t.

When I was in recovery after having Jack, my awesome nurse quietly mentioned to me that I would be an excellent candidate for a VBAC if that’s what I wanted and that I was with a great practice for VBACs.  Like I said, I knew almost nothing about VBACs and as we all know, I’m a researcher, so research I did.  Most of my early research was done while Jack nursed.  He was a slow eater and a comfort nurser so I spent a lot of time on the couch and thus on my laptop.  I read medical journals, blogs, web-sites, everything I could find.  I knew all the statistics.  I found out that 75 to 80 percent of women who attempt a VBAC are successful.  I learned that if your primary c-section is for a non-recurring reason (like a breech baby), you are the best candidate for a VBAC.  I found every statistic there was to find.  But I wanted more.  I joined a now defunct VBAC group (the group technically was absorbed into a well known message board, but it’s not quite the same anymore) with women hoping for VBACs, women who had VBACs and women who had unsuccessful VBAC attempts.  We shared information, stories, worries, etc.  I learned so much and to this day, I credit that group of women for my wonderful experience.  In almost any situation, a support system is invaluable, and this is no different.

First and foremost, I firmly believe that your VBAC experience is molded by your providers.  Your chance of success (obviously) goes up exponentially with a supportive team.  There are three types of VBAC providers.  Doctors that truly support VBAC; those that say they support VBAC, but either put so many conditions on your labor that it’s impossible to VBAC or they pull a bait and switch at the end of your pregnancy and start pressuring you into a repeat c-section; and finally those that will not allow a patient to VBAC.

Because the support of your provider is so key, I really recommend discussing VBAC with your provider early and often.  I talked to my doctor about VBAC at my 6 week postpartum check-up and again at my annual exam just a few months after Jack was born.  I wanted to make sure that my practice was indeed as VBAC friendly as they claimed to be.  At my very first appointment when I was pregnant with Xander, I made it clear that I wanted to VBAC and made sure that it was noted in the front of my chart.  There was at least a couple minutes of VBAC talk at every single appointment from then on.  I needed to know that my doctors were just as committed to VBAC as I was/am and I wanted to keep the communication going my whole pregnancy.

While the support of you doctor is key, the support of your hospital is probably just as, if not even more important.  Call your hospital and find out their VBAC success rates, how many VBAC attempts are made each year, etc (you should ask your doctor these same questions).  Find out if the hospital has any restrictions on VBACs that you can’t live with.  If your hospital requires a VBAC patient to have a RCS (repeat c-section) if they haven’t gone into labor by 39 weeks (often when doctors have these conditions, they come from hospital directives) your chances of success are pretty slim.

You will probably be hard pressed to find a doctor and hospital that doesn’t have “conditions” on VBACs.  Midwives tend to be much less restrictive.  The key is to find a provider who is supportive and who has conditions that you can live with.  Say your doctor requires continuous monitoring, are you ok with that?  Or some doctors require an epidural or not going more than a week past your due date.  Are these things that you are willing to agree to?

If your providers can’t give you the experience that you want, find new providers.  It’s hard to leave a trusted doctor or hospital, but you need to think about you, what you want, what’s you feel is best for you and your baby.

Once you find a provider you are comfortable with, you need to lay out some expectations for what will happen at the end of your pregnancy and during labor and delivery.  Will they use pitocin to induce or just to augment a stalled labor?  Break your water?  What will L&D be like?  My goal was to essentially have a plan for labor/delivery.  With Jack, I never had a single contraction and was convinced it would be the same with Xander.  Part of my labor plan was to discuss induction methods with my doctors and have a plan in case I didn’t go into labor on my own.  I was probably 5 or 6 months when my doctors and I formalized this.  I did my own research and came up with my own plan and laid it out for the doctors.  We put a plan in place that had an induction scheduled for 5 days after my due date.  My doctors were comfortable with letting me go up to 8 days past my due date, but I refused to be in the hospital for Jack’s birthday which was 9 days after my due date.  We discussed induction options but knew that this would be dependent on how favorable I would be for induction if/when the time came.  This plan was important to me because I needed to know that everyone would be on the same page at the end of my pregnancy.

The next part was hard for me.  I had to make a plan for what I wanted/didn’t want if I had another c-section.  I knew from Jack’s birth that there were things I loved (holding him as I was wheeled from the OR) and things I hated (cath insertion before spinal), so I made a list of things, a c/s birth plan if you will.  Everyone’s list will be different, but the idea is to know what you want or don’t want if you need another c-section.  I honestly never discussed the list with my doctor.  I was afraid that they would think I was wavering on my VBAC decision.  I wasn’t, I just wanted to be prepared this time.

And speaking of being prepared, be prepared for the unexpected.  And then be prepared to research the unexpected.  I don’t know why I was surprised, but late in my pregnancy it was determined that Xander was still breech.  I think I was about 30 weeks.  I was devastated.  I started seeing a chiropractor, doing all the exercises I could find, and nothing seemed to work.  So I began researching external versions and VBAC patients.  In typical Amy fashion, I researched the hell out of it and found that no uterine rupture had ever been attributed to a version.  At my 36 week appointment my doctor started down the “your baby is breech, maybe we should schedule a c/s” speech.  I said I would rather discuss a version and he made that face.  A face that said he wasn’t thrilled with the idea.  My response was “External versions are not contra-indicated for a VBAC.”  He immediately softened and we discussed it.  He was willing to give it a try after my  next growth ultrasound.  (It turns out he made that face because he is not good a versions, has a terrible success rate.  He would have referred me to another doctor to perform the version)  Fortunately, it never came to that because the ultrasound showed that Xander was head down.  The point being, doctors are often more receptive to an informed patient.  Make it clear that you already know the risks and outcomes and that you want to have a discussion about them, but at the same time, listen to your doctor’s opinion.  Then make a decision together.

I really do believe in making a decision together with my doctor.  In my birth story, I talk about how my doctor and I spent my 39 week appointment discussing our options.  We were at a point where I was having some pretty strong contractions that were doing NOTHING. My doctor sat down with me and we discussed every.single.option in great detail.  He left the decision up to me and I ultimately decided to be induced using a foley catheter (which was my suggested induction method).  I felt good about my decision because we had an open, honest conversation with my doctor.

Now, this is gonna sound like strange advice, but if  you can have your VBAC at a teaching hospital, do it.  Typically, teaching hospitals are much  more open to VBACs.  My doctors did a lot to try and make my VBAC happen, a foley catheter, pitocin, amnio-infusion, letting me labor for 8ish hours at 7 cm.  It’s a lot of stuff that is safe if done correctly, but a lot of doctors/hospitals won’t do it.  The day I had Xander, my nurse had a student shadowing her.  There was also a medical student around too.  I remember thinking that I was so happy that these students were witnessing what was happening.  I remember hoping that they would see my care and know that it is possible to induce a VBAC, that an amio-infusion can be done on a VBAC, that as long as the mother and baby are safe, you can keep going if that’s what the mother wants.

The hardest thing to prepare for was an unsuccessful VBAC.  I knew going into my pregnancy that induction and another c-section were a possibility.  I tried to mentally prepare for it.  I fretted and worried.  What if I didn’t bond with the baby? What if an unsuccessful VBAC caused postpartum depression?  I knew an unsuccessful VBAC might happen, but nothing I did truly prepared me for the moment when my doctor sat on the edge of my bed, took my hand and said a c-section was the best option at that point.  It didn’t matter that my husband I and had already decided that a c-section was best.  It was still hard to hear.  And that’ ok.  It’s ok to be sad, upset, disappointed, mad.  Own your feelings.  Process them.  Talk about them.  Heck, even blog about them.

And my final lesson.  If your VBAC isn’t successful, you DID NOT FAIL.  Your body didn’t fail.  You didn’t do anything wrong.  Circumstances just didn’t allow for your VBAC.  I often throw around the term “failed VBAC”, especially on Twitter but, it has more to do with the 140 character limit.  Because who in their right mind could call bringing this into the world a failure?

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