"There is no such thing as "perfectly safe" in birth. And both repeat Cesarean and VBAC carry increased risks. It's not as if one is safe and the other is not; it is that each woman must weigh the risks and benefits of each - and take into account logistics and payment and access and all that other stuff - and decide what's right for her and her baby." -www.ImprovingBirth.org
When I was building a birth plan for my first pregnancy I did the typical overly-involved, detailed list of instructions. I knew that things probably wouldn't go exactly as I'd written out, but I was naïvely anticipating a feeling of being in control. Long story short, about 10 things on my 100-item birth plan actually happened. My daughter was born via cesarean when, after 17 hours of un medicated labor, she let us know (in a big way) that she needed medical intervention. When her heart rate dropped to a dangerous 29-30 beats per minute there was no doubt in my mind that I had no control over any part of this birthing thing. I tried my best, and my wonderful OB gave us every opportunity he could to follow my impossible birth plan, but the situation turned life threatening and my nightmare was becoming my reality. You can read the whole experience (here).
Now, having the life of your unborn child nearly taken away is traumatic enough. Then, add in seeing your own intestines laying out on your stomach- it's the thing horror movies are made of. And lets not forget the terror of being unable to feel or control your own body (shaking, trembling, puking, chills) because of the rush of medications and pain blockers they hurriedly pumped into your body, all while being flooded with emotions and questions; "Is she okay?", "When can I see her?", "When can I hold her?", "What went wrong!?", "Is it my fault?", "Is my body broken?"....a literal stream of overwhelming feelings and questions. All of that, the "in the moment" experience, is traumatic. But what comes after is its own brand of trauma.
It took me a very long time to come to terms with my cesarean. There were months of questioning my own body. Whether there was something I could have done differently; ate, drank, or exercised more? Could my body even have delivered a baby? It took until around six months after my daughter was born that I could even admit that I "gave birth". I felt that I had no idea what it meant to "give birth". That was something I missed out on. As far as I was concerned, even though there was this beautiful perfect baby girl in my arms and despite the hours of hard labor I prayed through, I didn't feel like I actually had any right to say, "I delivered a baby". I remember a conversation with a nurse in which she asked, "When did you give birth?" and I answered, "I didn't." She looked at me so confused. But it was the most honest answer I could give.
It's not that I didn't appreciate or understand what the cesarean had done for us. It saved my daughter's life. She literally would not be here to aggravate and impress me every day if it hadn't happened. And, if you read her birth story, there were some pretty awe-inspiring moments in there. But there was just something in me, in my mind, that felt robbed and incomplete in my birthing experience. And there was never any person to blame. Nobody to be mad at. Nobody was at fault. Everyone around me (including myself) did everything right. I think part of me knew that from the beginning but there was still a sense of injury that I couldn't shake.
Then, there was the physical recovery. I was prepared for the 2 weeks of wearing the mommy-diaper-burritos made out of pads and Tuck's, the cramping and even the tears and possibly stitches...and for the wonderful sits-baths everyone talks about. It never seemed like a real option that I would be confined to my house recovering from surgery and unable to drive or do my normal household routine, with limited mobility, for six weeks. And I was definitely not prepared for the giant surgical incision stapled and stitched shut across my tummy. I felt like some kind of Frankenstein experiment. "Just hold a pillow when you cough or sneeze" they said....yeah right. I felt like every giggle or deep breath was ripping those staples out. I was just sure that when I pulled the pillow away some organ would be stuck to the pillowcase. I tried to downplay how much the surgery affected me to make it easier on myself (and, more honestly, to make it easier on everyone else), so much so that I actually thought I could go two hours without pain meds. The first day home I opted out of a Percocet dose...big mistake! For me, taking pain medications and not being able to pick up after myself or walk without help was more than just a burden. It was a daily reminder, flashbacks of all those scary and uncontrollable emotions and feelings of failure surrounding the cesarean. And the emotional injury far outlasted the physical healing. After educating myself on my specific situation (umbilical knots, reading my medical charts, speaking with other professionals), I was able to come to terms with what had happened and to realize that it could not have gone any other way. But, it was certainly not something that healed nicely like the scar on my tummy.
Fast-forward to two years later, I'm a week late, and three pregnancy tests confirmed: I'm pregnant again! In those two years I'd done a lot of reading and asking around about VBAC's (Vaginal Birth After Cesarean). I knew that I was a good candidate because there was no indication that my body was unable to birth a baby. The complication came from a tight true knot of the umbilical cord with my daughter, and the chances of that happening even once is between 1-3%. I interviewed multiple care providers, read statistics for repeat and first cesareans by hospital, and asked for personal experiences from friends, acquaintances, midwives...people who had homebirths and those who opted for repeat cesareans, and everyone else I could get in contact with. I knew I wanted a VBAC, but I wanted to hear from everyone and know a little bit about every experience. Ultimately, I found a group of midwives who work within a hospital (just in case), and who have a c-section rate of just 4%. They were well known for putting most of my "birth plan" into their common practices anyways (things like delayed cord clamping, non-chemical options for induction, and most importantly- no mandatory cesareans!). They were over an hour away, but there was no other alternative for me. While there were great doctors in closer hospitals, they were all held to their hospital's policies of mandatory induction via Pitocin (which can cause increased risks for VBAC), mandatory cesarean at 39 weeks, or mandatory repeat cesarean for every patient. While I understand the hospitals may "need" those policies in place to protect themselves, there just wasn't enough evidence supporting those restrictions for me to accept anything less than a fair chance at the healing birthing experience I needed (no organization that I know of endorses any of those policies in a low risk pregnancy like mine).
So, my second pregnancy was completely normal (just like the first). My midwives had many discussions with me about ICAN (a resource for women and families considering VBAC) and about the short and long term risks and benefits of my options to chose repeat cesarean, TOLAC (Trial Of Labor After Cesarean), and VBAC. Having such a supportive and informed group of medical professionals was priceless...honestly, the best decision I could have made with this pregnancy was to trust them with my prenatal care. Because I'd reached 41 weeks and 2 days with my daughter, we knew that I was a long-gestator (I invented that term), and we prepared to wait it out.
At my 40 week appointment they did a non-stress test to monitor the baby's activity and heart rate. A non-stress test is very simple; they strap a couple belts loosely to your belly for 20 minutes to an hour to see how many times baby moves, and monitor their heart rate during those movements. They're checking to see that baby is reasonably active and that he/she can adjust their heart rate when necessary. My baby boy passed the test, and we scheduled a 41 week appointment. Aside from the usual aches, swelling, and popping pelvis that comes with the end of pregnancy, the next week was uneventful. At the 41 week appointment, we passed another non-stress test, and scheduled a 42 week appointment. We also discussed (again) the alternative induction methods (balloons, gel, etc..). I thought, for sure, I'd make it to the 42 week appointment.....but nature took over and I went into spontaneous labor the night of my 41 week appointment.
Labor was relatively quick for me. At 10 pm I started feeling dull but consistent contractions, and by 10:45 I decided to start timing them. They started out at about 3 minutes apart and lasted about a minute each. There was a little bit of a panic deciding between "Should I wait it out to see if it's false labor?" and "Holy cow they said to go in when they were 5 minutes apart!". I woke my husband up, texted the appropriate people, and my husband drove like he was in a real life game of Grand Theft Auto. We made it in record time (probably 30 minutes!), but by the time we parked the car my contractions were already a minute apart and lasting almost 2 minutes each. They tried to wheel me into triage but just as they put the brakes on the wheel chair my water broke and the nurse said, "Nope, you're going straight to the room."
Between contractions I somehow managed to change into my PrettyPusher and they inserted an IV port (not attached to anything, so I could walk around and do whatever crazy positions I needed to get in to labor easier). Of all the things I tried to do while in labor, getting into that laboring tub was the best idea anyone ever had. I now understand why so many home births are delivered in a kiddie pool! I lost complete track of time (and honestly couldn't tell you what my nurses looked like either because my eyes were closed most of the time), and it was daylight before I knew it. During all of this, I actually didn't think about how this was going to be a TOLAC/VBAC or about what was going differently this time- I just focused on what I was feeling. This was a whole new experience, and I tried to keep Ina May Gaskin's advice in mind: Don't think of it as pain, think of it as a unique feeling you've never felt before.
In the moment, that's exactly what it was: in the moment. There was no comparing the two experiences at the time, but afterwards I realized it really was something completely different. Nobody mentioned the word "cesarean" like they had with my daughter. (With my first, nurses were coming in and out doing their checks mumbling things like "if this goes on much longer we'll have to do a cesarean" and "this is how my last cesarean was going".) Nobody seemed rushed. Nobody seemed to mind me taking my time. Nobody came in every 10 minutes suggesting pain relievers.
It was more than just the staff, though. I felt like I could trust my body again. I could trust it to go into labor when my baby was ready. I could trust it to breathe deep and slow. I felt stronger. Like I was doing exactly what my heart needed to heal itself.
My intention was to deliver completely naturally and un medicated, but at around 8cm I chose to leave the labor tub and get back into bed and call the anesthesiologist. I thought back to a previous conversation with a family member, when she commented about how she felt that she was able to be more involved and focused after her epidural. She said that without having the pain to distract her, she was better able to appreciate what was going on. At that time, being so close to delivery, I trusted my instinct that I would need that kind of calm and focus. I am completely satisfied with how far I went in natural birth. Even with the epidural I felt the contractions, they just weren't as strong. I still felt the urge to push, and after just a few times, my 9.5 lb baby boy came into the world via successful VBAC!! My midwife later told me she was proud of me for listening to my body and waiting for him to come on his own, and for making the choices I did. She also called me a "Beast at birthing" and told one of the nurses that it was a "Rock star delivery". That felt kinda awesome! Even if it was a little exaggerated on her part, it was exactly how I felt about it! I couldn't have asked for anything more.
As for the postpartum recovery, compared to what I experienced with the cesarean, it was a piece of cake. I got those mommy-diaper-burritos and sits-baths, and even though the bleeding lasted a little longer than I'd expected, I was able to go out by myself in just three days. I could take a shower, cook for myself, play with my almost 3 year old, and feel "normal" relatively quickly. For me, choosing VBAC was an incredibly healing experience. And that is why I'd take a vaginal birth over a C-section any day.
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