delivery

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.

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Dr. Hartung


Here I am with my baby’s doctor right after everything was over with. Dr. Hartung was amazing! (He practices at Hudson Hospital in Hudson, Wisconsin.) We live in the Twin Cities (Minneapolis) so we drove about 1/2 hour to each appointment with thim.

He was open to me making the birth experience whatever it was that I wanted it to be. Even though it ended up in a c-section, he encouraged me to try for a vaginal birth but left the decision up to me. After meeting with many people who were motivated only by risk management, it was refreshing to have a doctor that was motivated by birth being as natural an experience as possible while having respect for medical issues that could arise.