VBAC Victory!

By Stacey Escoffery

Although I was never happy about the cesarean section I had in my first pregnancy, I at first accepted it and considered it a necessary precaution. I even used to tell people that my scar was not a big deal; I called it my badge of honor. However, more than a year later, when I was ready to get pregnant again, regrets about my C-section surfaced for the first time.

The anger and sadness I felt about the labor and delivery of my firstborn daughter became overwhelming. Once, at work, I came close to breaking down in the middle of a meeting, and many times I awoke in the middle of the night to find myself feeling the foreign and permanent bump on my bikini line—the thick, red, raised scar of a hypertrophic keloid. To me, the keloid seemed a manifestation of my underlying, unresolved anger about the C-section.

Perhaps we should rename keloids "angry scars." I was angry because someone had, without cause, invaded my body and robbed me of the experience of a natural childbirth. At first, my anger was directed solely at my obstetrician, but then I realized that I was also angry at myself. During my first pregnancy I was scared of the pain of childbirth, and uneasy about not being in control of what kind of birth I would have. So when my doctors told me that my labor would need to be artificially induced, I felt a bit relieved. A scheduled birth would mean that I would have more control over the process.

Or so I thought.

A series of events led up to my C-section. Toward the end of my pregnancy, I had a slightly low blood-platelet count of 113, which I now understand is not threatening at all (150 is considered a normal count). My obstetrician told me I could risk hemorrhaging during labor if labor was not induced about ten days before my due date. During my second pregnancy I had the same blood-platelet count, but the several doctors I consulted told me that it was no reason to induce labor.

My doctors told me that my baby would be large—at least eight pounds. This surprised me. Everyone in my family weighed about five and a half pounds at birth, and I had gained only 23 pounds during my pregnancy. I should have trusted my instincts—my baby weighed only 5 pounds, 14 ounces when she was born—but I ignored the small voice inside that told me not to listen to them.

The day I checked into the hospital, my platelet level had returned to normal, but the doctor proceeded to induce labor regardless; I felt pressured to go through with it to avoid inconveniencing my doctor or the hospital. Again, that small voice inside told me to leave, but having been already admitted, it seemed like too much trouble. I stayed.

They gave me Cervidil, which prepares the cervix for uterine contractions, injected Pitocin to stimulate my uterus to contract, and manually broke my water. But because my baby was not yet ready to be born, the Pitocin-induced contractions resulted in fetal distress. Watching my new daughter's heart rate fluctuate was terrifying. The doctor told me that she needed to perform an emergency C-section to save my baby. After I was rushed into the operating room, I was told that my daughter's heart rate had stabilized, but the doctor proceeded with the surgery anyway, as a "precaution."

When I saw my daughter for the first time, it was a miracle. I'd never felt so happy in my life, and cried and cried with happiness to see her. I yearned to hold her with every fiber of my being, but the medical staff would not give her to me. My doctor said that I would have my whole life to hold her. After a few minutes, they did briefly put her on my shoulder, but then took her away again and wheeled me off.

Back in my room, I was in agony. The nurses would not lift me from the bed but made me get up on my own. I knew something was wrong—the pain was so bad—but not once during that long day did my doctor check in on me. The next day, she finally came to see me, read my chart, and noticed that "someone" had forgotten to give me postsurgical pain medication. After the surgery, the pain, and the much-needed but late-administered drugs, I didn't feel confident about my ability to take care of my baby that first night. I decided to start breastfeeding her the next morning. When I did, I was so exhausted and in so much pain from the surgery that I had a very hard time.

The more I learned about what my choices could have been, the more bereft I felt. Through this grief I realized how much I needed to respect my own body, honor my feminine power, and cherish my womanhood. Respecting my body meant protecting it from unnecessary surgeries, and fighting for my right to stay with my baby in those early hours after birth.

Most people did not understand my grief, let alone its depth. They told me that I had a healthy daughter, and that was what mattered most. Many women even prefer C-sections because they can schedule them at a convenient time (although the six weeks needed to recover from the surgery is not what I call convenient). With C-sections, doctors can also control their schedules—no 2 a.m. calls or long, arduous labors—and they're paid more for the procedure. They are also understandably scared of lawsuits. It is rare for a doctor to be sued for a C-section, because it is considered a baby-saving procedure. The problem is that C-sections are no longer used solely for emergencies. The 2004 rate of cesarean sections in the US was 29 percent, up 40 percent since 1996.¹ In anticipation of my next pregnancy, I tried to find a practitioner who would support my desire for a vaginal birth after cesarean section (VBAC).

I consulted with several OB/GYNs in Nassau County, where I live, on New York's Long Island. All used scare tactics to discourage me. One doctor said he believed a VBAC was the safer way to go and would support me, but asked me not to advertise it.

Each time I read or heard a story in the media about the drawbacks and unpopularity of VBACs, I felt discouraged. Still, I felt that a VBAC was my chance to be reborn and start anew. I did not want any drugs—I wanted to go into labor naturally and push out my beautiful child. I wanted to nurse and cuddle my baby as soon as he came out. I did not want anyone to take him from me. Another C-section was not an option, but I knew I needed support.

During my search, I learned that our society worships fear and control and does not trust women to do what has been a natural process since the beginning of time. If you ask women who have had C-sections why they did so, most will say that something was wrong with them. But today's woman is the same as yesterday's woman. All that has changed is that our society has invested in the medicalization of birth, and lost its confidence in women along the way.

In my search for a VBAC-supporting birth team, I stumbled on a community of caring advocates of natural birth. I found two doulas as well as a childbirth educator who runs healing circles for women who have had C-sections. I also met with a retired OB/GYN who inspired me to trust myself. He told me that he had delivered babies for more than 50 years and had seen all sorts of situations, such as twins and breech births, that would now be considered grounds for a C-section, but that he had delivered them vaginally. Where has this sort of doctor gone? Today, despite the rise in unnecessary cesareans, Consumer Reports magazine recently named the procedure number three on its list of "12 Surgeries You May Be Better Off Without."²

When I found a midwife who had had two VBACs herself, I felt as if I'd found a life raft. I drove an hour to meet her and the other midwives of the Midwifery Practice at Stony Brook, far out on eastern Long Island. Though I strongly believed I could trust my body, I also feared my uterus would rupture (even though that happens in less than 1 percent of VBACs). To reinforce my belief in my body, I wrote the story of my ideal birth as if it were reality, then rewrote and reread it daily:

The baby inside of me is born vaginally with no complications whatsoever. My labor is short and drug-free, and is much less painful than I think. The baby is perfectly healthy, happy, and filled with love. The baby is born safely and easily, when he is ready, and he is positioned in the easiest possible way for birth. He will have no fetal distress at any time. He thrives spiritually, emotionally, physically, and intellectually, now, at birth, and forever.

I am thrilled to report that my VBAC could not have been more successful, and that my labor and delivery exceeded my expectations. It was surprisingly exhilarating to be "out of control." I got to the hospital fully dilated and ready to push. Attending me were my husband, two midwives, my doula, and two labor-and-delivery nurses, one of whom had had a VBAC herself. The room was filled with inspiration. My labor was short, and although the experience was intense, the pain was not half as bad as my previous doctors had led me to expect. To rise above the pain, I went to a place inside myself that was very private and powerful. It reminded me of the inner power I'd found ten years before, when I ran a marathon.

During my labor I felt supported and taken care of. I did not feel like a liability or a legal risk. Instead, I felt embraced as a woman in labor who trusted her body. Everyone in the room was rooting for me—I knew they wanted my delivery to go well. The baby's heart rate never wavered. I pushed my little one out and he was immediately placed on my chest. One of the first things out of my mouth was a "thank you" to the director of the Midwifery Practice at Stony Brook for performing VBACs.

Today, I feel complete and fulfilled as a woman. I have a love of my body that I never dreamed was possible. I have let go of the disappointing and unnecessary experience of my cesarean section and the grief of the distant past. I could not have asked for a better gift from God. The people, place, surroundings, and timing of my labor and delivery were all a miracle—one that I worked hard to assemble through research, effort, and a passionate desire to have the birth of my dreams.

NOTES

1. Todd Zwillich, "Preterm Birth and C-Section Rates Up," WebMD Medical News (15 November 2005): www.webmd.com [1].
2. "12 Surgeries You May Be Better Off Without," Consumer Reports MedicalGuide.org (30 November 2005): www.consumerreports.org [2].

FOR MORE INFORMATION

• Doulas of North America—An international association of doulas trained to provide the highest quality of emotional, physical, and educational support to women and their families during childbirth and postpartum. www.dona.org [3]
• International Cesarean Awareness Network—ICAN's mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting VBACs. www.ican-online.org [4]
• Midwifery Today—The editors of this magazine believe that midwifery is not a thing of the past but a viable profession and, more than ever, the best choice for birthing mothers today and in the future. www.midwiferytoday.com [5]
• VBAC.com—A woman-centered, evidence-based resource. Their aim is to provide access to information from a variety of sources: scientific studies, professional guidelines, government reports, successful and safe established VBAC programs, and the midwifery model of care. www.vbac.com [6]
• VBAC, HBAC, VBAMC RESOURCES
  

Stacey Escoffery is a personal trainer and owner of a marketing-communications consulting firm. She lives in Garden City, New York.