The Trouble With Wanting A VBAC

With first babies, you have all the choices in the world how to give birth — drug-free, with a doula, in a hospital surrounded by the family, c-section. Not that the plan always works out, but a mum-to-be can dream.

With subsequent babies, however, the options narrow quickly for a group of women who, for whatever reason, wound up giving birth to the first via caesarean section.

Pamela Paul’s article in this week’s Time, “The Trouble With Repeat Cesareans,” would more accurately be titled “Hey, Good Luck With That VBAC.”

Paul doesn’t set out to argue whether women should be allowed to choose to give birth via c-section. Rather, she illustrates how, for an alarmingly large number of women, the choice to give birth vaginally isn’t even there — c-section is the only apparent option.

She writes that although VBAC is a safe option, nine out of 10 women with a prior ceasarean undergo repeat cesareans for subsequent births. Of course repeat caesarean might be the woman’s choice, but vast numbers of are basically forced into the operating room.

From Time:

…the International Cesarean Awareness Network
(ICAN), a grass-roots group, recently called 2,850 hospitals that have
labor and delivery wards and found that 28% of them don’t allow VBACs,
up from 10% in its previous survey, in 2004. ICAN’s latest findings
note that another 21% of hospitals have what it calls “de facto bans,”
i.e., the hospitals have no official policies against VBAC, but no
obstetricians will perform them.

These bans left one California woman to drive 100 miles to a hospital where she would be allowed to attempt a VBAC.

This is interesting because the National Institutes for Health, recognizing the tremendous cost and associated risks of surgical birth, has set a goal of decreasing the number of cesareans by, in part, upping the VBAC rate to 37 percent by 2010. In 2006, VBACs only accounted for 8 percent of all births in the U.S.

Paul counters the studies and VBAC safety fears many women, doctors and — probably most importantly — insurance companies operate under. And explains how we got to where we are today, even though just over 10 years ago, attempting VBAC was quite common. Several high profile lawsuits sent malpractice insurance through the roof. She qoutes a doctor who admits the “once a cesarean, always a cesarean” is an issue of money, not patient safety.

Paul also writes on Huffington Post her own experience when she wanted a VBAC. She found who she thought was a VBAC friendly doctor, only when she was six months pregnant he wanted to talk c-section scheduling. She balked and when she went in to give birth, the on-call doc at her supposedly VBAC-friendly hospital wouldn’t talk to her while she was in labor and didn’t answer his pager when it was time for her to push. Lovely!

I’m curious whether what hoops you had to jump through to get support for a VBAC or if you had to through in the towel. If you had a repeat c-section, was that your choice? Avoiding the battle?
Photo: Time