The most frequently asked question in my life right now is “How does Leela get along with the baby?” But second place is “I’m considering having a VBAC (vaginal birth after cesarean), can you share about your experience.” So – here goes! Keep in mind, I’m not a doctor, just sharing my experience and my best understanding here.
A little background on my c-section
In July 2014, I had my first baby Leela. She was breech and despite every attempt to turn her, I couldn’t get her to budge. I scheduled an external version, but my fluid levels were too low to attempt it. Because of concerns about the low fluids plus the breech, I had a c-section at 38 weeks. I was devastated. I’m a holistic health coach and wanted a natural childbirth. I was with a midwife practice, hired a doula, read a dozen books about natural childbirth, watched every episode of Call the Midwife. I ended up having a highly medicated birth, surgery, a difficult start to breastfeeding, and a tough recovery. I never went into labor, had a contraction, had my water break, or any of that “fun” stuff that you see in the movies.
A different approach with the second pregnancy
A year later, I got pregnant with my second baby, Rumi. Since using a midwife practice and putting so much energy into wanting a natural childbirth had backfired the first time, I took a different approach. I chose a conventional ob-gyn practice (Weill Cornell) and told my husband “I am not making having a VBAC my big crusade.” If it happens, great. If not, I’m going to be ok with it. Basically, my plan was to apply reverse psychology and pretend it wasn’t super important to me, in hopes that that would make it happen.
Discussing VBAC with my doctor
From day 1, I told my doctor that I would like a VBAC if possible. She needed to see my hospital records from the c-section in order to determine if I was a candidate for a VBAC. I think they mainly look to see the details of the incision. Based on looking at my records, she said I was a candidate for a VBAC. She was pretty neutral about it. I certainly could have chosen a practice that is more supportive of VBAC, but instead I chose a practice most convenient to where I live, with short wait times and good Yelp reviews (because living in NYC is ridiculous and you make decisions based on stuff like that here!).
Coasting through pregnancy
I had an easy and uneventful pregnancy with Rumi. I didn’t obsess over the VBAC. However, I did stay very physically active for two reasons. 1, because when Leela was breech her head was stuck up in my ribs. It was so painful. I felt like if I kept exercising, this baby wouldn’t get stuck. 2, because I didn’t want any complications such as gaining too much weight to “disqualify” me from a VBAC. You see, if you have had a c-section in the past, you can’t get induced because your scar could rupture. So if there are any complications, you’d go straight for a c-section. So I made it a point to eat well and exercise in the spirit of doing my part to avoid complications. At every doctor’s appointment I would ask “are things still looking good for a VBAC?” and they would say yes and I’d consider that a victory.
3rd trimester – getting discouraged
Towards the end of the pregnancy, I felt that my doctor shifted her tone and became rather discouraging about the VBAC. At my appointments, she would list 5 different things that could disqualify me – if the baby was too big, too small, too early, too late, etc. I learned that my hospital had only a 13% VBAC rate. I felt that to have a VBAC was like getting through the eye of a needle. I was kind of annoyed with myself for not choosing a practice that is more supportive. That’s when I started to do my research so I’d be empowered to make this happen.
My research on VBAC
The best resource out there is: http://www.ican-online.org/. I reached out to my local ICAN chapter and they were really helpful with answering some of my questions. I also did google searches on “how to have a successful vbac” and basically searched for stories from moms who had vbacs.
I also did field research. My friend who is a doula asked me to be the pregnant model at a class she was taking on fetal positioning. The class took place at the very end of my pregnancy and I got to meet a bunch of doulas who had VBACs themselves and attended VBAC births. It was very encouraging and empowering. I started to feel optimistic. I hired a doula, feeling that would help me to labor at home for a bit longer than my husband and I would be comfortable doing on our own.
Why did I want a VBAC so badly?
There are so many reasons! A few:
– I have a toddler. I was worried that after a c-section I wouldn’t be able to pick her up for 6 weeks, which would be crazy hard.
– I wanted the experience of pushing out a baby. It seemed crazy to me that I could have 2 babies and yet never have a single contraction.
– I wanted an easier recovery.
– Despite all the hype that VBAC is less safe, a second surgery is not without it’s risks. I didn’t want another surgery.
– I am just a crunchy granola person and vbac was my strong preference.
Managing my emotions
By the end of the pregnancy, I was no longer pretending that a VBAC didn’t matter to me. However, I spent an hour journaling about my birth experience with Leela, processing those emotions, and that helped. I felt like I could accept either outcome. And if I had a second c-section, I felt my recovery and healing would be MUCH better because I would know what to expect and wouldn’t allow myself to wallow in disappointment like I did with Leela’s birth.
At my 39-week appointment, my doctor told me “I’m at the hospital all weekend, I hope to see you there!” (Remember, we didn’t want the baby to be late, because then I’d have to get a c-section, since I couldn’t get induced.) On Thursday I wrapped up all of my work projects. On Thursday night, I took a long walk with Leela, bounced on a yoga ball, and ate eggplant parm for dinner (wives tale that eggplant parm –> going into labor). I was ready. Low and behold, I started having contractions that night. Woke up on Friday morning, and called the doula to come over. Karan had a dentist appointment and I told him there was still plenty of time and to go. The doula and I labored at home. Karan came home. Then, whooosh, things started to go REALLY CRAZY FAST. I told them, “we have to go to the hospital NOW.” We left Leela with the sitter and had one of those dramatic cab rides where the poor cab driver must have been seriously worried that I was going to have a baby in the back seat. We got to the hospital, and I was 10 cm dilated. Oh boy. My doctor said, “I’m sorry but it’s too late for me to offer you an epidural, the baby’s head is here and it’s time to push.” Rumi was born within 1 hour of my arrival at the hospital.
Recovery from VBAC vs. c-section
Neither one is a walk in the park! However, the recovery from my unmedicated vbac was much better. It felt amazing to be able to walk around, pee without a catheter, EAT, and not sleep with those puffy things on my legs. After my c-section, I was confined to bed for 12 hours, was not allowed to eat for about 20 hours, had so many drugs running through my body that I was throwing up while nursing Leela for the first time, and it took a full week for my milk to come in which was incredibly stressful. After the vbac, I did have a few stitches, plenty of soreness, and took my full dose of Motrin for a good 2 weeks. But – there’s no comparison. Not having surgery = easier recovery for me.
My words of advice
A few things I learned:
1. If you’re committed to having a VBAC, choose a practice that is known for being supportive of them. In everything I read, that’s the #1 thing you can do to increase your chances. I did not do that and wish I had.
2. Choose a doula who has attended a VBAC birth.
3. Don’t labor at home till you’re 10 cm dilated! That’s not something I intended to do, and I’m not sure why my labor went so crazy fast at the end, but it was scary and I don’t recommend it.
4. Find a way to accept either outcome, because I believe that will support your healing.
5. Get educated about VBAC, there are a lot of myths around it. For example, some people think that you can’t have a VBAC if it’s been less than 2 years since your prior cesarean, but that is not true. Also – uterine rupture happens in only 1% of vbac births. This is a good article: http://www.vbac.com/making-informed-decisions-about-vbac-or-repeat-cesareans/. Also – ACOG (American College of Obstetricians and Gynocologists) says this: In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. Read more here.
6. You often hear, “all that matters is a healthy baby.” I don’t love the way that statement diminishes the mother’s birth experience. While a good outcome for mom and baby matters most, there is still room to advocate for the birth experience of your choosing. There is still room to be empowered and have a preference. It’s your body and your baby.
7. Manage fear. There’s no question that the phrase “uterine rupture” is a scary one, and I had to find a way to manage my fear. For me, reading positive birth stories was helpful. I really love the book Baby Catcher. Also – AVOID AT ALL COSTS talking to people who might make you more fearful. I wanted to be well-informed but not to hear horror stories.
8. Nothing is perfect. While having a VBAC was a triumphant and wonderful experience for me, when Rumi came out she had difficulty breathing and was in the NICU for the first 2 days. Even though I had the drug-free vaginal birth of my dreams, we didn’t get skin-to-skin contact and I couldn’t breastfeed at all for 2 days. Ironic, right? For anyone who wants a VBAC I would recommend to go for it, but … truly all that matters is a healthy baby.
I hope that’s helpful!
Sending all the best wishes for a healthy birth ~
Sending all the best wishes for a healthy birth ~