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.

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.

Changing the World: One Changing Table at a Time

Note: This isn’t only about changing tables. It’s about making a difference in our world.

My quest to change the world one changing table at a time started when I went into a Starbucks in Duluth, MN when my daughter was about 18 months old, had a messy diaper, and I wanted a decaf, no-foam latte. Alas, when I entered the oversized bathroom there was no changing table. I was shocked. I couldn’t believe that Starbucks would fail to install a changing table at a location in the middle of a large city.

I did then what I consistently do now when I don’t see a changing table. I said to the staff,

“I see that you don’t have a changing table. Where would you propose I change my child? On the floor?”

They looked at me blankly and shrugged their shoulders.

I then proceeded to change her on one of the cushy oversized armchairs in the middle of the coffee shop.

Now don’t get me wrong. I realize it is not the staff’s fault that there is no changing table. But what I hope is that word will get back to the manager that a disgruntled customer changed her messy child (read poopy) in the middle of the coffee shop.

This was my first course of action.

When I got back to town and went into my local Starbucks I again found no changing table. I called the manager, wrote several emails and persisted until I was able to speak to a district manager. I asked her what Starbucks’ policy was on changing tables. She looked into it and found out they had no policy. (If you do a web search on Starbucks and changing tables you will find that I am not the first to notice this problem.) She explained that I was catching them at the right time. They were doing a remodel and would be sure to install a changing table. I was also offered a free coffee drink of my choice the next time I went in. Bonus!

Here’s a blurb from a quick web search for “starbucks changing table.” Apparently this woman’s successful method was to use Twitter.

“Speaking of Twitter, that’s actually where I finally started to get somewhere with this whole situation.  I followed @Starbucks and (with the help of @JetWithAnya) asked them to put me in touch with the people who could hear me out.  After an email back from Starbucks Coroporate Communications that *didn’t* tell me to waste my time by entering it on the L-A-M-E webpage, I learned that I needed to contact my local District Manager. So the next time I was at my local store I grabbed her business card and shot her an email when I got home.  I explained my frustrations (and made it clear that I would be blogging and Tweeting about all of this, one way or the other).  To her credit, she has been extremely responsive and friendly, and after only two phone calls, put in an order for changing tables for my local store.”

Recently, a similar messy diaper situation occurred at Sebastian Joe’s, a very popular ice cream parlor in the Twin Cities. In this instance, I Facebooked Sebastian Joe’s until I got a response. The owner asked me to email him. I emailed him and a few weeks later got a phone call from explaining that they were going to be adding changing tables to their two locations. (I also got an offer of a free cone.)

If you want to make a difference in your community in some way here are some ways to go about it: 

  • While you are in the location ask to speak to the manager
  • If no manager is available, ask for the manager’s email address or phone number
  • Call and ask to speak to the manager
  • Write a letter, (here’s an example letter that I wrote to an icecream parlor) mail it and follow up with an email or a phone call
  • Ask in your letter that the establishment respond with a plan of what they will be doing to rectify the situation
  • Post a message on Facebook
  • Post a message on Twitter
  • Be persistent

The need for change is highlighted when you have a young child and are forced to meet his or her needs, oftentimes quite urgently. I was recently in a grocery store deli seating area by myself and was thinking perhaps my daughter and I might go there together to eat one day. I took a look around. Lots of chairs, lots of tables but not one high chair or booster chair.

Hmmm..perhaps my toddler and will pay them a little visit. After an hour of her running around the deli they are going to be racing out to buy a high chair!

Good luck in your endeavors whatever they might be!