Thursday, June 19, 2014

Fighting for a VBA2C

If you have been reading The Happy Wife for a few years now, you might remember that my fifth baby was an emergency C-section, due to him tying his umbilical cord into a true knot.  What you might not have known, was that it was my 2nd C-section.  My first-born had also been a C-section due to my water breaking spontaneously, but my body failing to go into labor, despite several interventions to try to get labor started.  I was fortunate to have hospitals in my area and OBs that were favorable to VBACs and the 3 babies in between were all born via VBAC.  That included a 10+ pound baby, and 2 babies that were induced early due to pre-eclampsia (1 was severe pre-eclampsia with HELLP syndrome).  I know in many areas it is difficult to find hospitals and/or OBs that are willing to allow a VBAC, so I was very grateful to live in this area.  However, I also know that there are even fewer areas that have hospitals and OBs that are willing to attend a vaginal delivery when there has been more than 1 C-section. 

I also want to say that the OB I started going to when I was pregnant with #3, is someone that I have a lot of respect for and truly trust.  I also really like the hospital that he is affiliated with and wanted to deliver there as long as it was medically feasible.  The other hospitals in our area are good hospitals, but I have had much better birth experiences at my preferred hospital.  When I learned I was pregnant, I dreaded the upcoming conversation with my OB, as I was afraid that I was going to have to choose between finding a new doctor and my wish of being allowed a "trial of labor" in the hopes of having another successful VBAC.  I started by doing my research regarding VBA2Cs (vaginal birth after 2 C-sections) and the risks involved.  I learned that a successful VBAC had a better outcome than a repeat C-section, but a failed trial of labor , often had a worse outcome than a repeat C-section.  I also learned that in 2010 both ACOG (American College of Obstetricians and Gynecologists) and the NIH (National Institute of Health) had issued statements regarding VBACs, including VBA2Cs.  ACOG's statement specifically states, "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans."  The statement by the NIH discusses the risks and benefits of VBACs and what factors influence the success or failure of a trial of labor. 

I gathered my research and prepared myself for my first prenatal appointment with my OB.  My OB starts every primary prenatal appointment in his personal office before having you go to a room for the physical exam.  This gave me the opportunity to discuss my concerns with him.  When our meeting started, he stated that he had already heard that I wanted to try a VBAC (I had talked about it with the Nurse Practitioner when I came in to confirm the pregnancy.)  I stated that I did and steeled myself for a fight.  As I sat in his office, with tears streaming down my face, I tried to assure him that my decision was an educated one and not merely an emotional one. I left his office with the same fears I had entered with, but with a flicker of hope that he had promised to talk to the other doctors and to the hospital to see what could be done.  At my next appointment, he apologized because there had not been enough time at their meeting to bring up the VBA2C, but he promised he would do it.  A few nights later, he called me and told me that he had spoken with everyone who might be involved in my birth. I held my breath as I waited for him to tell me what they had decided.  I was beyond thrilled when he said that all of them were willing to support my decision to have a trial of labor.  He told me that he did not want to admit it the day we met in his office, but that I had been right about my risks being equal either way and that he used that information when he presented the situation to the other doctors.  He also stated that my successful VBACs in between the C-sections played a large role in the decision.

Sooooo...........did I end up with a successful VBA2C or did the pregnancy result in another C-section?  Stay tuned., the birth story will be the next post.

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