Why VBACs Should Be the Norm, Not the Deviant Care Pattern

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Guest post by Allison Phayre, Ph.D.



There are so many problems with the “best standard of care” according to obstetricians.  My experience is so typical.  I assumed that my medical care was evidence-based, and that the advice given to me by my OB was based on what was best for ME & MY BABY, not what was best for HER.  I was dangerously uninformed, assuming that my doctor had my best interests at heart…I WAS WRONG.  And it happens every day to so many women.  It doesn’t matter what level of education or socioeconomic status a woman holds—the minute she entrusts her care to an OB following the “best practice” model, she signs away her right to her intelligence, her possession of her own body, her health, and the best interests of her family. 

Because I was a sheeple, I followed along with my OB’s advice to have my 2nd child via c-section, even though the ONLY REASON GIVEN was that he was “measuring big”.  It did not matter that I had successfully birthed my first child of 8 lb, 10 oz two years prior—now he was “too big” for me to birth, and I was fear-mongered into a c-section with discussion of shoulder dystocia.  I hated it.  Words cannot express how violated I felt, and how disconnected I felt from my son.  My arms were strapped down, and I felt trapped.  I was not allowed to wear my glasses in the OR, and never got a good look at him when he was born.  They took him away to the nursery, and even though they told me they were going to do this, I did not realize how it would make me feel.  All I wanted was my baby, and they kept him from me for over an hour.  I just wanted my child, and I had to wait, alone, in the OR, while they stitched me back together…my husband was with our son.  They bathed him without me, weighed him without me.  When I finally got to hold him, I wondered whose child this was—he was all cleaned up, and I just did not feel like this was the baby who was a part of me for nine months.  Looking back, I see how it impacted my bond with him.  I got so frustrated with him when he was gassy as a newborn—I had to let my husband take over caring for him several times in the middle of the night because I just didn’t care why he was crying.  I was NEVER like that with my first child.  I am sure in retrospect that I was suffering from postpartum depression.  I now had a ‘fat shelf’ over my scar, and I was horrified to discover that if I didn’t carefully dry off my skin, I developed yeast rashes.  My own body had been deformed permanently by this decision.  Wow.

With my third child, I desperately wanted a VBAC.  I read and read and read…I knew it was the safest, best choice for me and my baby.  My OB, the same OB, said she supported me with my VBAC plans.  I should have known better, and should have sought care elsewhere.  But then we hit 36 weeks, and after an ultrasound I was told that again my baby was “too big”, and she “wouldn’t allow me” to have a VBAC attempt.  I was SHOCKED.  Did this woman not already know that I had big babies?  8 lb 10 oz for my first at 37 weeks, and then my c-section birth of my son, who was 10 lb 4 oz.  So how was it that I was allowed to think that she would support me in my VBAC plans when all along, she had the evidence right in front of her that my third baby was probably going to be “big” too?  I was left scrambling at 37 weeks, trying to find someone, ANYONE, who would let me try a VBAC.  All I wanted was the safety provided by the hospital in case I was one of those very rare women who have problems.  And NOT ONE OB within 2 hours of me would take me as a patient at that late stage of pregnancy.  Even the perinatology group that my OB (after professing her shock that I would still want a VBAC knowing how “big” this baby was) referred me to, would not accept me as a patient.  I had an emotional hour long meeting with my OB and my husband, where he clearly outlined the EVIDENCE that I had read about how much safer VBAC was, and how concerned I was about possible health effects of c-section birth on my baby (increased risks of allergies, asthma, eczema, etc).  And my OB told me she “didn’t believe” the studies in the medical allergy journals about asthma, even though she hadn’t seen them herself.  And she admitted that her rationale for denying my VBAC attempt was based on fear of litigation and restrictions from the hospital and her practice.  I am still boggled at this admission, that the medical care she provides to her patients is dictated first by insurance and hospital policy, and not by medical data.  WOW. 

I lost sleep.  I was so stressed there was no way I was going to go into labor naturally—and what options did I have?  I knew of no midwife who would attend a homebirth VBAC, and my husband was terrified that something would happen and he would lose me & the baby.  I could try to labor at home, not knowing if the baby was doing okay (we wanted fetal monitoring in labor), and show up ready to push and insist on the opportunity.  But what women need in labor is support, not arguments.  And I had to face this terrible surgery, knowing that the risks fall more heavily on me, the mom—and I already had two living, breathing kids who needed me!  How could anyone ask me to willingly make a choice that I KNEW was riskier for me, when I had those other children to consider?  It’s as if any living children are irrelevant to these decisions, and only the baby is important!  And that is just WRONG!  I was so afraid of feeling disconnected again from my baby, I couldn’t bear the thought of this surgery. 

Eventually after much heartache and prayer I consented to a repeat c-section with my daughter.  But I was not done fighting.  I fought to have a better birth, even if it wasn’t what I knew was the best choice by the data.  I insisted that my daughter remain with me after birth.  I insisted they not clean her up, and that my arms were free to hold her, and that I wore my glasses so I could clearly see her.  They did no weighing in the OR—the doctors had to go without knowing her birthweight.  She was wrapped up in warm blankets, and my husband held her next to my head so I could touch her and talk to her and kiss her while I was stitched back up.  And I held her in my arms, ME, while I was wheeled into recovery, and I started breastfeeding her right away.  And it was better, but it still wasn’t right. 

Now my third child is seven months’ old and I find myself thinking, maybe I would be up for having a fourth child…maybe our family isn’t complete yet.  But I am given severe pause due to my two c-sections.  I worry about the increased risk of complications for me and any future baby.  It’s not an abstract risk.  My sister-in-law miscarried at 19 weeks with her third child, due to her baby’s placenta implanting on her scar tissue.  They are real risks, and they are scary.  And it makes me sad that I am forced to think about constraining my family’s size due to these risks.  I don’t know if we will try to have a fourth child, but the fact that that choice has been severely impacted for us, is another unnecessary side effect of unnecessary cesarean births.  I am still angry at that OB for practicing medicine the way she does, and I am mad at myself for not educating myself sooner, for not saying no to that first c-section and waiting to see what my body & baby could do.  I am working on forgiving myself, and on healing from the effects of surgeries.  I no longer see that OB.  I have switched practices to another OB with a much lower c-section rate, and a birth philosophy that more closely matches mine.  Maybe I will have a fourth child.  In my area, I don’t know if I can fight for a VBA2C.  However, I think my chances are much better with a different doctor who seems to put her patients first.  

And that is why we need to reform our maternal healthcare model.  Because medical care should be about caring, not about processing people like they are sheep.  All medical care should be evidence-based, with the best interests of patients put first.  I am a Ph.D. scientist, and when I worked in a lab (now I teach, to spend more time with my children), I was not allowed to change how I did things just because it would be easier for me, or my administrator told me to do it, or it would be more convenient for our lab if it worked a certain way.  I had to make decisions on how to proceed based on evidenceMedical care, of all types of science, ought to be based on evidence!  If I am required to practice science according to the data, then how much more so should a doctor be required to practice medicine according to data? 

I hope my daughters will have a better maternal care system in this country, when they are old enough to birth their own children.  The complete miracle of birth and new life has been lost by the obstetrical profession as a whole, and that is just another clear indicator that a reevaluation is needed.  Maybe if enough women speak up, we can effect that change. 


Submitted to the ICAN VBAC Blog Carnival

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