Vaginal Birth After Cesarean – Make an Informed Choice

When I was 28 weeks pregnant I ended up changing obstetricians.

A year before getting pregnant, I had surgery on my uterus. Basically, my situation as a pregnant woman was similar to that of a woman who had previously given birth via cesarean and was pregnant again.

When I went to the doctor I assumed I would be able to have a vaginal delivery because my surgical report stated that it was not contraindicated. In other words, the surgeon said there is no reason this woman can’t give birth vaginally. However, during the first ten minutes of my first OB visit the female doctor I had chosen informed me that a cesarean at 36 weeks was mandatory in order to reduce all risk of uterine rupture (which is reported as less than .01%).

Full term is 40 weeks.

The doula I later hired was appalled. She said, “That’s like planning to deliver a baby prematurely.”  

As this was my first pregnancy I assumed the doctor was making a sound medical decision and that this was my only option. However, it was only after I began searching for hospitals that allow skin-to-skin contact following a cesarean (something my doctor would also not agree to) that I learned I had other options and that my first doctor was taking THE most conservative approach.

I was furious that it took me 28 weeks to learn that I had options.

During my interviews with other doctors, I learned that some doctors would not even think of performing a cesarean at 36 weeks. I learned that many women choose to have trials of labor, to attempt vaginal deliveries, and still others, after weighing the risks, to have cesareans, usually around 39 weeks. At no point during the many months I was treated by my original doctor was I informed of these options or given any autonomy in this decision.

Why didn’t my doctor explain my options to me? Why didn’t she explore what was medially possible rather than just taking the most conservative approach? Why wasn’t I involved in the process of making this decision?

This doctor’s fear-based approach to this health care decision was less than empowering.  She basically gave me the impression that I could die in my living room at the first onset of contractions if I chose not to deliver by cesarean at 36 weeks. I was panicked at the thought of making a decision contrary to her’s. She was seemingly prioritizing the hospital’s and the clinic’s liability over the health of the baby.

In addition, she was not open to other opinions. When I informed my doctor that I would be getting an opinion from a perinatologist (a doctor who specializes in high risk pregnancy), she stated, “I’m sure he will have the same opinion as I do.” When asked if a differing opinion would change her mind she stated that it would not.

Contrary to the information she gave me, I learned that from other doctors that a uterine rupture was a very unlikely event and that a later cesarean could easily be scheduled with little risk to me or the baby. There was a general consensus that attempting labor following uterine surgery involves risks and if I was motivated to take that risk then these other doctors would be willing to accompany me on that journey. At the same time, they would all be just as comfortable scheduling and performing a cesarean at 39 weeks or even later if that was what I wanted. It was a hard decision, but I felt better knowing that I had been given all the information in a non-biased way and that the decision was mine. From all of these providers I was left with the impression that we would be negotiating a treatment plan and that we would be working together as a team.

The medical treatment I received at the women-only clinic was not consistent with their motto. The website stated, “At [our clinic], we strive to help you be as informed as possible while you make your health care decisions.” I question the ethics of an approach that withholds information and options available to women. I would encourage all clinics to adopt such a motto and to take it to heart as all women deserve to make personal, informed choices about their healthcare.

I chose my original clinic because of its all-female staff and because I thought I would be treated from a woman-centered approach. However, my experience was quite the contrary. I did not experience my treatment as woman-centered, nor did I experience my treatment as being respectful of my rights and autonomy regarding choices around my healthcare. A health care clinic that prides itself on an all-female staff should provdie a practice that empowers women and values her right to free choice and information regarding her delivery options.

In sum, there are many women who would prefer to attempt labor following uterine surgery or a prior c-section. However, a woman must have all of the facts and options available to her so that she can make an informed choice.

Unfortunately, cesareans are on the rise because doctors shy away from VBACs (Vaginal Birth After Cesarean). If you are pregnant and have received an opinion from a doctor that recommends an early c-section or a repeat c-section, consider seeking a second opinion. The last four weeks of development for the infant are crucial in regards to its long terms health and well being. The lungs are still developing and there is evidence to suggest that babies born before 36 weeks are more likely to have asthma. Get all the information you can and make the best decision for you and your baby.

http://ican-online.org/

http://www.vbac.com/

At 42 weeks Dr. Hartung, of Hudson Hospital and Clinics, delivered my beautiful baby girl via cesarean due to medical issues unrelated to my prior surgery. She was a happy and healthy baby.

13 comments

  1. You are offering a forum for women and mothers who are afraid to ask questions about their health, welfare and well being of their children. Makes people think. Thanks.

  2. Thank you for sharing your story. It is important the people realize that doctors are human beings,and make mistakes. Do your own research, get second and third opinions, and find the care provider that is right for you. I wonder what happened to your first doctor that made her so squeamish about vaginal birth after uterine surgery. Perhaps she had a bad experience.

    1. Yes, that is one hypothesis…Perhaps she had experience a negative outcome and did not want to have that happen again. I just wish that she had shared all options with me from the beginning and then told me what SHE was willing to do. It would’ve made the process a lot easier.

  3. It would have been better if she had told you about the options. I wonder why she didn’t. Is it because she didn’t know the options, or because she didn’t believe in the other options and didn’t want you to have the choice of something she didn’t believe in, or ….? I am reminded of a doctor my husband saw for back and neck pain. I asked the doctor about chiropractic as an option, and his response was, “I would never let a chiropractor touch my back or neck, it could cause paralysis.” In the end, my husband had surgery (which could have caused paralysis) and he will never be able to have a normal, healthy spine again….

  4. Obstetricians are also surgeons at heart. As an NP who works with many docs, I can tell you that sometimes surgeons feel more comfortable when doing surgery. A vaginal birth cannot be ‘controlled’ in the way that a cesarean birth can be. Even though it is considered major surgery, the obstetrician faces less malpractice risk when performing a C-section. “The Business of Being Born” is a good documentary that highlights this issue.

  5. That is an excellent point, Shelly Robert. I had forgotten that Obstetricians are also surgeons. My own ob took me by surprise when he got down on the floor and showed me exercises to help my transverse baby move to a better position. I was impressed.

  6. That’s a very good point, Shelley, and, yes, I’m pretty sure that my doctor, or even the clinic, was basing her or their practice on risk reduction, not on a woman’s choice. I was just telling a woman yesterday that the difference between a doctor who promotes a VBAC versus pushing for a scheduled c-section is a matter of comfort level. Dr. Hartung is extremely comfortable doing VBACS and feels that he can manage the risk effectively. The other doctor apparently did not have that same comfort level with VBACS and thus pushed for the c-section.

    I’ve heard a lot about “The Business of Being Born” but I’ve never seen it.

    1. That is sad. First of all, a due date can be wrong. So they may induce a premature delivery. Can’t she wait until she is in labor before going to the hospital? They won’t come to her house and induce her at 41 weeks 1 day…will they?

  7. I know! That’s exactly what I said – are the 41 weeks 1 day police going to knock on her door? I actually called the OB unit where I delivered and asked a nurse what a woman can do in a case like her’s. They told me she can refuse to be induced. That the patient has the autonomy to do what she wants. She agreed that it was a very conservative policy. I encouraged the woman (it’s her first baby) to advocate for herself and her wishes for her pregnancy.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s