I’ve been doing a lot of sitting on the couch lately, working with a set of premature twins in my neighborhood. They are sweet and cute and screechy and vomit-y, and all the things that you could reasonably expect little people to be. It also means that occasionally, between physical therapy exercises, massage, and wiping spit-up off my shirt, I get to watch some CNN. Like many people, both men and women, who I hang with, I was shocked to hear Democratic strategist Hilary Rosen’s comments regarding Ann Romney and her decision to stay at home with her boys, rather than work outside the home. Now this is not a political blog, and I won’t go into my own personal beliefs here, although I will say that I value good manners from all parties. What struck me, and seemingly much of the rest of America is the fact that once again, women are being divided, and once again, we are doing it to ourselves.
This lack of cohesiveness is certainly nothing new in feminism, and regrettably, it is nothing new in the birthing community. But, you know what they say about familiarity, and I am certainly feeling a bit of contempt right now for a situation that’s a-brewing in the Seattle vbac community. Let me tell you a story:
Once upon a time, Dear Ones, there was a little community hospital. It didn’t have a Level III NICU, but it had nurses who would gently love your baby to sleep at the desk, if you needed a nap yourself. It didn’t have flat screen tvs or a bath tub in every room, but the rooms were large enough to stroll around, and the showers were big enough for two. There was an ob group there, and a few independent nurse midwives who had privileges, as well as a family practice doc or two for variety. They had nurse anestethists, rather than dedicated anesthesiologists, and all seemed to work very well for a while. Oh, and they did vbac. Lots and lots of vbac.
But the only constant is change, Dear Ones, and progress must be made. The flat screens went in, and the ob group gradually morphed into another set of personalities. The nurses still loved on the babies, most of the independent midwives eventually left, and an official CNM group was established. Oh, and the vbacs went away.
You might think, Dear Ones, that this is the end of the story, that this is one more rant about how the opportunity to vbac is being slowly taken away. But no. Actually, now the vbacs are coming back! The obs are willing to accommodate vbac on a case by case basis, depending primarily on the reason for the primary cesarean. They are especially fond of those reasons that are “non-repeating. “ In obstetrical language, this includes a breech baby, placenta previa, and basically any other condition where you had to schedule a c-section before the labor waves hit you. It also helps if you have had a previous vaginal birth, have no underlying health conditions, like long walks on the beach, and are a Capricorn. (Ok, that was a bit snarky. You caught me.)
So you would think we would be celebrating, right? After all, isn’t any vbac a cause for celebration? Yes. Yes, of course. But I’m still upset, and I’ll tell you why.
While there is some statistical difference between the “success” rates of vbacs based on the initial section, it also really really doesn’t matter. If the Big Bad Wolf of VBAC is uterine rupture, why does it matter how the scar got there in the first place? If we are going to be scared of scars, let’s really commit to it. Let’s be really really scared. Let’s have a vbac ban that is honest. Let’s not try to hide our own fear behind a colorful wall of half examined statistics and rupture stories our colleagues told us on the nightshift. Nights are dark and cold, and even the extra cardigan in your locker can’t protect you from half buried truths, based on old school traditions and your sister’s scheduled repeat cesarean.
Even ACOG clearly states that VBAC is a “safe and reasonable choice for most women,” who have had one c-section, and even for “some women” with two.[i] It says nothing about “non-repeating” conditions, although it does specify that a suspected big baby, carrying twins, or going over 40 weeks are not reasons for a mother to be denied a VBAC. (It actually says denied a TOLAC-trial of labor-but that language is another post for another time.)
And, by the way, vbac is successful 75% of the time.[ii] This is actually a better chance than an every day, run of the mill, first time mama, who has a 67.3% chance of a vaginal birth.[iii] And by the way, in 1965, the C-section rate was only 4.5%[iv] Just sayin’.
Jodilyn and I have said for over a decade that 99% of a vbac happens in the mind, not in the uterus. The research, the personal exploration, the soul searching, the intense wanting, means everything. A supportive provider certainly helps, as does a partner who is on board. But at the very end of the day, it is a mother’s journey. She needs allies, certainly, but the journey is definitively her own. She is the one who has to fight the doubts, and ultimately believe that she is not broken. She may be a bit bent in spirit, but eventually most women can believe that most of the time, her uterus and her mind are strong.
So what does it do to a mother who is already working through her process, when she is told that not only does she have to live with the results of her c-section, but that she didn’t have the right kind of labor before her section? And what does it do to her faith in the medical professionals who tell her that, when she realizes this is a completely arbitrary distinction?
[i] American College of Obstetricians and Gynecologists. (1999). ACOG Practice Bulletin No. 5: Vaginal birth after previous cesarean delivery. Washington DC.
[ii] Coassolo, K. M., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Nelson, D., et al. (2005). Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks Gestation. Obstetrics & Gynecology, 106, 700-6.
[iii] National Center for Health Statistics
[iv] Taffel SM, Placek PJ, Liss T. Trends in the United States cesarean section rate and reasons for the 1980-85 rise. Am J Public Health 1987;77:955-9.