An Unanticipated Choice: VBAC or C-Section?

Robin Marty

Having a baby still after a miscarriage still feels so unreal to me that having the decision about whether to undergo a scheduled c-section or attempt a V-BAC is itself surprising.

I have to admit I was pretty surprised to make it into the second trimester. Despite having a reassuring listen to the fetal heartbeat at about 10 weeks in an unrelated doctor’s appointment, I still wasn’t completely believing that it would make it through the first twelve weeks intact.  But at my 12 week checkup everything looked perfect, and I was hit with a something else I never thought about — how I want to give birth.

I had made the assumption that, just like the last time I was pregnant, my only option was to have a second c-section.  When I told my doctor, who is a general practitioner, that I was pregnant last September, he informed me that he couldn’t see me anymore until I had found a surgical OBGYN who would be performing a c-section on me, since he wasn’t qualified.  If that doctor was willing to share duties, then I could continue with my regular doctor with the understanding that I would switch to the OBGYN closer to full term, and schedule the c-section then.

But now, six months later, a change in both insurance providers and hospital policy has brought a new set of possibilities into my life.  I could actually go with a VBAC (Vaginal Birth After Delivery). And, in fact, my regular doctor was encouraging me to do so.

I need to be honest.  Part of me liked having the choice taken away from me.  A c-section appealed to my sense of order: I would know exactly when it would happen, what to expect, how long it would take, what the recovery would be like.  And yes, it is surgery, with additional complications and a longer period of recovery than a vaginal birth, but still, I knew exactly what I am getting into.

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I had a very bad birth with my daughter.  After going overdue I underwent a two-day long induction period that did not do what it should to jump-start delivery.  Unfortunately, my water broke on its own near the end of the process, forcing us to continue on right when I was about to be sent home to rest and try again the next morning.  Fifteen hours later, after four epidurals, six hours on oxygen, a raging fever, an alarming increase in fetal heart rate and a diagnosis of “failure to progress,” it was agreed that an emergency c-section was the only option. I started the induction at 9 am on Monday and at 3 pm on Wednesday was the semi-conscious mother of a fat, crying little girl with an undiagnosed infection that passed on to her due to my prolonged broken water.  She spent ten days in NICU, I spent three in my bed trying to recover from severe blood loss. 

Once we were finally all home, we quickly recovered physically, but it took me months to come to terms with the loss of a happy, engaged labor.  There was no joyous moment when the family all came in to see their first grandchild with balloons and flowers.  Instead, we escorted each grandparent into the NICU one at a time, due to the visitation rules.  In the end, I know I should have been happy she recovered so quickly, that she was released before Christmas, that I didn’t need the transfusion the doctors were debating giving me.  But still I think about that wonderful birth moment we should have had, and still find myself sad.

I realize that with a VBAC I have the chance to recreate that day, to attempt to have the experience I felt like I was robbed of before.  So many things would be different this time.  This time I know that I am Group B Strep-positive, and would be on antibiotics, making the danger to the baby that much less.  I came into this pregnancy nearly 40 lbs lighter than my previous pregnancy, making me a much fitter and healthier patient, something that has great effect on how often you end up in complications or stalled labor.  They do not give pitocin to women who have had c-sections due to possible rupture, so I will be able to move about during labor, rather than be laying in bed the entire time like I had to for my induction.  In fact, they don’t allow any form of induction at all, meaning if I do go overdue I would end up with a c-section anyway.

Because that is my biggest fear.  Not a fear of labor itself, but of going through labor, failing again, and having another c-section after already pushing my body to the brink.  If I thought in any way that I would fail, I would rather just go straight to the surgery and deal with its consequences on its own.

But I can’t help but think that if my body manages to go into labor on its own, it’s already a victory, as I never did manage to do so with my daughter.  If that can happen naturally, of course it would make sense that I could labor and deliver on my own as well, too.

I change my mind nearly constantly, and I know that luckily I still have months before I have to make a final decision.  I weigh what would be best for me, best for the baby, best for my family, who would have to help care for me somewhat, too, in the case of surgery.  And in weighing all of these pros and cons I have to take a moment and look at my own fears, and recognize that those have to be viewed as a factor as well.

But mainly, as I think my way through the scenarios I find myself amazed that I get to decide this at all, and realize how lucky I am that, after everything we’ve been through, there might be any sort of delivery at all in December.  Finally, I think I can begin to think of this pregnancy as real.

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