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« VBAC vs. Repeat Cesarean: "Try on" both choices | So I got an epidural for my VBAC. Get over it. »
Saturday
Jun042011

"The unfortunate politics of VBAC"

This comment was left anonymously on Andrea’s post, So I got an epidural for my VBAC. Get over it.


Thanks so much for sharing your story. We’re currently trying to conceive our second child and even though I’m not even pregnant I’m already debating the VBAC or RCS question.  This should be a decision that is made by DH and me but for some reason I have this idea that if I was a “real” woman and a “real” mother I would try for a VBAC.  Like pushing a baby out of my vagina would somehow undo my c-section failure.  Intellectually I know it’s totally silly.  I’m a real woman and a real mother regardless of how my daughter was delivered.  But I think that deep down the NCB rhetoric has influenced me.  My daughter’s birth wasn’t “normal.”

Unfortunately I feel like my decision about whether my next birth should be a VBAC or a repeat c-section isn’t personal.  That my decision has ramifications for other women.  I also feel like the people who are advising me aren’t motivated by what is best for me but instead by what promotes VBAC access. 

I feel like if I decide to do the repeat c-section that people will be disappointed in me.  I feel like those same people will pity me or think it’s because I’m too afraid or something.  And that totally annoys me.  I’m a grown woman and am capable of making decisions for me and my family. 

That’s the unfortunate politics of VBAC.  On one side the doctors and hospitals see every VBAC patient as a potential lawsuit and want to encourage us to schedule repeat c-sections.  (I know I’m speaking very generally here and that some doctors are very pro-VBAC.)  On the other hand, the VBACactivists want all of us who have had prior c-sections to VBAC to advance the cause.  And then there’s a subset of that group that wants us to VBAC “correctly” which either means no epidural or a homebirth. 

But again thanks for sharing your story and I’m sorry that you felt judged for your decision to have an epidural.  It’s unfortunate that we women do this to each other.

 

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Reader Comments (35)

Or, there is the subset of us who truly want you to make the most informed and best choice for you and your family.

I am an ICAN chapter leader in a city with a hospital that delivers the most babies per year in the state of Florida (something around 16k/year), the third busiest in the country, and they have close to a 50% cesarean rate. I cannot describe the pain in my heart I feel when I survey OB offices and I hear "vbac is illegal" or "why would you do that, do you want your baby to die?" It gives me heartache and also pause. If I am just some random woman calling around asking "do you do vbac's?" and these are the answers I'm getting, how do I know that ANYONE in town is getting adequate information? I don't.

So, I have to trust that women are thinking for themselves, taking all of the risks, benefits, and alternatives into consideration, and not blindly accepting what their OB has to say about vbac (or what s/he doesn't have to say, for that matter). It has taken me YEARS to get to this point, yet I still have to bite my tongue when I find out someone had a cesarean. It is a conscious choice on my part and I hear myself every single time say in my head "never assume anything".

I guess that's part of my point, that we should never assume anything about a woman's birthing choices. With that said, oftentimes we have no other option but to assume simply because we live in such an individualistic society where few women publicly discuss their decision making process for their birthing choices leaving the rest of us to wonder what the heck happened. This poor communication our society prides itself on is its downfall, especially when it comes to reproductive choice.

June 4, 2011 | Unregistered CommenterAngela

When I was in the battle of my own VBAC, I was drowning in everything VBAC. I ate, breathed and slept VBAC. After the dust settled I had 2 very good friends that were pregnant with their second child, both deciding whether or not to go for a VBAC. One of my friends would not even speak to me and I assumed it was because she thought I would shove VABC down her throat.
And sadly, she was right.
But, after I came to this realization, I stopped. I told my friend I supported her decision whatever it was and ultimately she knew what was best for her and her baby. Yes, I had to bite my tongue when when I found out she was uninformed and that her husband pushed her to have a RCS so she could get her tubes tied instead of him getting a vasectomy. But, it wasn't worth losing the friendship.
I do disagree with your statement, "the VBACactivists want all of us who have had prior c-sections to VBAC to advance the cause." Not all of us. I just want women to be able to choose the way they birth. What they do with their their vagina should be up to them.

June 4, 2011 | Unregistered CommenterAndrea Owen

I would probably be considered a VBACtivist, but I don't think every woman should VBAC. I think every woman needs to make informed choices and have accurate information in order to choose which set of risks she is most comfortable with. I don't judge a woman who is informed and chooses ERCS, just as I don't expect her to judge my informed choice to VBAC. I do feel really bad for a mama who wasn't informed and chose ERCS, and is now on the harder journey on VBA2C. That's why I think its hard to know who to tell what. Maybe a woman just doesn't know there are options and Lord knows I wish I had been informed the first time around.

June 4, 2011 | Unregistered Commenterjenn

You are all assuming that it should be a choice. a Ceasarian Section is a major operation and should only be performed to save the life of mother and baby and not under any other circumstances. It's not about being an activist of any sort. If you don't feel like opening your bowels in case you split your sphincter wide open just get a colostomy bag. Now doesn't that sound stupid.

June 4, 2011 | Unregistered Commenterpurpleanvil

It's absolutely true that each woman's choice has ramifications for other women. That's not a statement intended to make anyone feel bad or pressured, it's simply a fact (not limited to this issue): we all live in this world together. I don't condone guilt-tripping anyone into any birth choice or demonizing people whose choices are different than my own. And, because of the nature of birth and its relationship with women's power in contemporary society, any choice has political significance. Understand and recognize the politics of your choice, and do what you will. Your choice is still yours alone--the result of a very personal decision-making process--at the same time as it is rooted in a highly complicated and uneasy political context.

June 4, 2011 | Unregistered CommenterAlisa

"You are all assuming that it should be a choice. a Ceasarian Section is a major operation and should only be performed to save the life of mother and baby and not under any other circumstances."

So are you saying that I shouldn't have the choice to have a repeat c-section? Who gets to make the decision, if not me?

Do you not consider the risk of uterine rupture, although small, to be enough of a risk to "allow" me to have a repeat c-section if I want it?

Remember we're not discussing primary c-sections here. Primary c-sections based only on a mother's choice are a different matter. We're discussing births after c-section where there are risks with both options (VBAC or RCS). Because there are risks with both options, a mother should be able to make the choice, IMHO.

Forcing women to undergo VBAC is no better than forcing women to undergo a repeat c-section.

June 4, 2011 | Unregistered CommenterAnonymous

I pushed very hard for a VBAC for baby #2...because it WAS something I wanted to do. Not b/c I thought it would undo the damage from my first birth but b/c I did not know how many more babies I wanted...and I knew that CS would effect that. I was living in Florida - like where someone mentioned you might get many doctors telling you that "vbac is illegal!"

I had a deadline. If I couldn't find a VBAC friendly provider by 22 weeks I would reconsider (I found out I was pregnant very early - I had lots of time - and I thought by this time I might be weary and be more thoughtful about the choices at this point). I found a provider at 15 weeks.

At 39 weeks my baby turned breech. My provider was no longer allowed by law to assist me...even though she said she "might be in the area" when I went into labor and could "stop by". I felt it was too risky for her, her practice, & for other women that might want an opportunity to use her services in the future. I didn't want to be the statistic & ruin things for her & everyone that relied on her. (And I did not feel comfortable being unassisted.) She found an OB who was willing to do surgery (and also willing to send me back to the previous provider if my baby changed position in the next week or two). I walked into the hospital on the morning of the c-section & felt GOOD. I had made a conscious choice to say yes to a RCS.

It did not undo the damage from my first birth, but I don't feel damaged from it...I had time to think about my choices, to make an actual informed decision...and say YES. My husband and I have talked about having a 3rd child. I absolutely would attempt another VBAC if I got pregnant. But if something happened to make me feel like that was no longer the best decision, I feel like at least I got the change to say yes...unlike that first time when I was just wheeled away...screaming, "no," at the top of my lungs...When you have that first section...It does effect our future choices...And how we VBAC (if we choose to). But I don't think anyone can say for anyone else that those choices are wrong.

June 4, 2011 | Unregistered CommenterMaegan

Of course its a choice! It may be a choice that you completely disagree with, but it is still a choice. People choose to have major surgery every single day. Some of it is needed, some of it is not. Who are you to tell them they can't make that choice for their own bodies?

June 4, 2011 | Unregistered CommenterLeah

I find the key statements in this post to be “doctors and hospitals see EVERY VBAC patient” and “VBACactivists want ALL of us”. For women to have truly informed choices, the information must be specific for that one INDIVIDUAL woman. A woman who had a very difficult first labor and then had a necessary cesarean delivery may actually have less risk (Birthrisk) if she schedules a repeat cesarean delivery whereas a woman who had a cesarean because her doctor had dinner plans may have less Birthrisk if she attempts a VBAC. Each woman is an individual with her own individual Birthrisk based on her unique combination of physical characteristics, we shouldn't group them together into “EVERY” or “ALL”.

If we want to improve outcomes we need to get informed. One way to get informed is from analyzing what has happened to similar women and learning from this history (Cesarean Rate History). You might want to call this “experience”. I have been helping women to delivery their babies for twenty five years and I have developed software that can give every woman and every obstetrical care provider the “experience” of over 285,000 deliveries.

My software is not intended for VBACs, but a woman contemplating a VBAC can get a free Cesarean Rate History at my website. Fill out the information like it is your first birth and you will at least get a ball park estimate of what has happened to women with similar physical characteristics who have attempted labor. GET INFORMED.

I always feel so sad that some women feel that all vbactivists would pillory them for deciding on a repeat c/s. I don't think most of us are like that at all. We simply want women to fully understand their choices, to make well-informed decisions, and to make sure that women really DO have a choice in the first place.

However, there are some folks who are really that judgmental, and sadly, they make the rest of us look bad. I definitely get frustrated with that element of the movement. But let's be fair....every activist movement has its extremist element. That doesn't negate the importance of the movement or its work; it just reinforces the need to keep lines of communication open so others don't think that extremists represent the view of most folks in the movement.

Yes, I do want more women to opt for a VBAC if that's right for them, because from a public health point of view I think there will be fewer downstream health problems on a societal basis with fewer cesareans. But on an individual basis, each person has to choose what's right for them, and no one should be forced into VBAC or ERCS.

I do think women can be truly informed and still choose RCS. And in fact I have supported women who chose ERCS. My support is done on an individual basis and is not dependent on their choices, but my vbactivism is done more for a public health point of view because of the large-scale changes that need to happen in the system. The problem comes when you advocate on a public health basis and people hear it as being about their individual choices. For me, anyhow, it's not.

What I tell individual women who are struggling with the choice is to "try on" both choices and to remember that they have plenty of time to make their decision. You really don't need to make this decision NOW, it's perfectly normal to feel ambivalent about the choice, and there's NOTHING WRONG with considering both choices, or even with deciding not to decide for a while. Sometimes it's great just to be pregnant for a while without having to make any choices.

Then, when you are ready, take a few weeks and "try on" each choice. It's not enough to try them on for a couple of hours or days; it's really more optimal to work through this by trying them on for longer periods. That way you get past the surface reactions and emotions and get deeper about what your concerns are with each choice.

Try on the repeat cesarean first. If you are like me, you'll feel a real sense of relief at first....at having the decison made for you, at not having to worry about going through labor again, at not having to worry about "failing" etc. Perfectly normal responses. After a while, picture yourself really going through with this choice, including going into the hospital at xxx weeks and laying down for that surgery. Does that picture bring a sense of relief or anxiety, or some of both? Picture the surgical recovery too, which might be uneventful and no big deal or which might include difficulty with movement, sleeping, and a fair amount of pain. Then try to anticipate how you'll feel about the decision afterwards. Some feel nothing but relief about not doing labor again, while others end up disappointed in themselves for not trying VBAC, and still others feel a little of both. 5 years down the road, how do you think you will feel? Glad or not?

Then take a few weeks to try on a VBAC. How does that make you feel? Does it create a huge sense of anxiety, or does voluntarily signing up for further surgery create more anxiety? Which makes you feel more worried....the idea of surgery or the idea of labor? Why? If labor makes you anxious, what can you do to make this birth different so it's not just a repeat of last time? What if you had a really supportive caregiver and birth support team? What if you could have a VBAC? How would you feel about that 5 years down the road?

Most people consider the what-ifs of "what if I 'fail' and have another cesarean anyhow?" and that's certainly a worthwhile consideration. Not everyone has a VBAC....but although that's hard, a CBAC doesn't have to be life-destroying. It takes time to process but many of us have done so and survived. But don't forget to also consider the what-ifs of "what if I DO have the VBAC?" If you did have the VBAC (which you have about a 2/3 to 3/4 chance of doing), how would that make you feel? Would that feel like a real sense of accomplishment or not that big a deal? What does it mean to you?

You have to consider the big bad what-ifs, of course. People nearly always consider the big bad what-if with VBAC, which is uterine rupture. Having known women who have had UR, I never minimize that. It really is a big bad to consider. However, what people often fail to consider is the big bad what-ifs with ERCS, and I've known folks with these as well (pulmonary embolism, hysterectomy, massive hemorrhage, damage to bladder and bowels, etc. etc.). Both UR and serious morbidity from ERCS are unusual outcomes; the chances of them actually happening to you are quite small. But because they can be so serious, they certainly are worth considering.

But also worth considering are the big GOOD what-ifs. What if everything goes perfectly fine? What if baby and I both have a great outcome, either way? Chances are quite high of a good outcome with either VBAC and ERCS, much more likely than a big bad outcome. So if you had a big good what-if outcome, would you rather that come from a VBAC or ERCS? Would it make any difference to you emotionally?

Additionally, think beyond to any future children. If you planned more (or had an ooops), this birth influences that one. Think through those long-term decision trees too. Think of your possible downstream outcomes. What would you prefer from that point of view?

These are all things to ask yourself as you try to process this decision. Truly, I'm not trying to tell you which way you "should" feel, just communicating the possibilities. I hope I don't sound patronizing; I'm just trying to give you some tools that some (including me) have found useful in making this difficult choice. I've been in ICAN for many years, had a CBAC and then 2 VBACs, and wrestled pretty hard with the ERCS vs. VBAC choice myself with #3. Yes, in the end I chose VBAC, but I very much understand the appeal of ERCS and have supported women who have chosen that, as well as women who have chosen VBAC. I know the things that helped me in my own decision tree on the topic, and what seems to have helped others, which is why I include them here. If these ideas aren't helpful to you, please feel free to totally disregard them.

I can tell you are well-informed about your choices, but I'm sorry you feel pressured one way or the other. Wouldn't it be nice if women could make these choices in a neutral space, free from rhetoric from all sides? But alas, we don't live in such a world yet. In the meantime, try to free yourself from the pressure and expectations of others, try on the decisions one at a time, get in touch with your deepest feelings about each and their what-ifs, and then in time I bet your decision will come clear to you.

Trust yourself to know what you need to do. Just remember that you don't have to decide this right NOW; you have time and space to think it through and consider all the angles. But trust yourself......you'll be able to make this decision and figure out what you need.

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