One of the overarching issues plaguing this pregnancy from the beginning has been whether to attempt a vaginal birth after cesarean (VBAC) or schedule a planned cesarean and skip the laboring part altogether. I’ve been battling with this decision since before I even became pregnant and definitely do not take it lightly. I ask anyone who has experience in the area for their thoughts and regularly harass my poor friend who is a labor and delivery nurse. I was so close to giving birth vaginally to Waverley– I labored for 24 hours, she crowned, I even tore down there– that I’ve always felt a bit dissatisfied with how her labor and delivery went. Obviously having an emergency cesarean is no one’s first plan but sometimes is the safest option for mom and baby. (I am grateful I live in a country where that option is readily and safely available and that we both survived sans any long-lasting health issues.) However! The emotional impact of giving birth via cesarean is not one I considered. Now that I am pregnant and nearing my due date again, I can’t help but wonder if I am missing out on a fundamental part of motherhood. It’s something I never would have even thought of until delivering vaginally didn’t happen. Even now, I certainly don’t look at other women who have only had cesareans and think “Oh she is less of a mother/woman.” That is ridiculous.
“In my head, the fantasy ends with cheers, tears, and validation of so much effort.”
The medical justification for Waverley’s cesarean ended up being a case of macrosomia, which just means giant baby. Waverley was 10 lbs, 7 ounces with a head size in the 100th percentile and there was no way my body was capable to push that out. The reason for her size, we know now, is simply genetics. There were no underlying health issues on either end, just the unique genetic makeup given to her from Nate and I. Given the reason for the cesarean we have kept an extremely close eye on the growth of this baby and I have undergone frequent ultrasounds from a perinatologist rather than solely relying on fundal height measurements. Nate and I decided early on that if this baby’s size is closer to “normal” I would try for a VBAC. I just couldn’t shake the fantasy of the excitement of going into labor (I had to be induced with Waverley at 41 weeks), rushing to the hospital, and after hours of labor successfully pushing that meatball out. In my head, the fantasy ends with cheers, tears, and validation of so much effort– akin to passing boards or killing it in a swim meet. This would fulfill all of my competitive needs for being capable and able.
“Unless I go into labor naturally, I’ll never know the rush of speeding to the hospital…”
We had a plan and an OB well-practiced in VBACs. Then the trajectory of this baby’s growth began to increase. The prediction of her size is now on par with her big sister; At the rate she is growing, she will likely weigh around 10 lbs at 40 weeks and her head size is already in the 94th percentile! We are faced with a dilemma. Do I let go of my fantasy in lieu of what is inexplicably the safer option? Do I risk another brutal recovery because I have such a high chance of needing a repeat cesarean if I do wait it out and attempt the VBAC? Am I willing to risk this baby’s life in a vain attempt to deliver naturally? For those of you unaware, the risks involved with a VBAC attempt include a ruptured uterus and pose more risk to the baby than the mother.
“I am grateful I live in a country and time where the option for an emergency cesarean is readily and safely available.”
After speaking with two perinatologists and my OB, we have come to the conclusion that a repeat cesarean is the safest option to ensure a healthy baby and mother. Unless I go into labor naturally prior to August 16th, I’ll never know the rush of speeding to the hospital or what it feels like to give birth naturally, which I feel like are integral parts of pregnancy much like walking down the aisle at one’s wedding. Does this make me any less of a mother or woman? I don’t think so. I think we are just choosing what is best for the health of our family. With so many birthing options available, it’s especially important to resist passing judgement on other mothers for how they choose to bring their babes into the world. Whether it’s a water birth, doula-assisted in a hospital, or a scheduled cesarean, we are all doing the best we can with the information provided to us. In the meantime, I am going to relish in the convenience of scheduling the birth and the ability to make a plan– two of my favorite things!
I’d love to know, how did you deliver your little ones? Did anyone attempt a VBAC with success?
I say give it a try!! I loved natural childbirth..it is hard work but so worth it!!!
Thanks for the encouragement!
I went with a scheduled cesarean. Our first little guy was breech from the moment we first saw him in the ultrasound. I even had an aversion done but the little stubborn boy just snapped back to breech. With our second I went to a different, more private OGBYN practice and my OB didn’t perform VBACs so my decision was essentially made for me. But that didn’t make it any easier on my mentally. Like you said I felt like I’d miss out on all the excitement of a natural delivery. Jason was happy because that meant he wouldn’t need to reschedule his patients since he would know the exact date of the birth! Anyway, in the end it was a so much more enjoyable experience than our first because I knew what was happening. My recovery was 1000% easier as well. And we got a beautiful baby boy in the end which is all that matters! (Sorry for the long comment- I am just so passionate over this topic since I’ve gone through it!)
Thank you so much for your comment and sharing your story! I loved reading about it and it made me feel so much better. I totally get your point about non disrupting work schedules– it’s really convenient when paternity and maternity leaves can be planned! It sounds like you gave it a ton of effort the first time around to delivery naturally. I did, too, so I think that helps with not being able to have a VBAC; I know I tried as much as possible! I am also super glad to hear the 2nd time around was easier. My first recovery was so brutal and I don’t think I could do it again, especially with a toddler to look after! And, yes, in the end a healthy baby and mama are all that matters:)
When I was pregnant with my son (baby #1) I went to the perinatologist because of a history of high blood pressure. In this case they closely monitor size because mothers with hypertension tend to have smaller babies. My hypertension was very well managed though and after several months of growth measurements we saw a case of macrosomia as well (I was born at 9.5 lbs and my brother was 11lb 12 oz, so the genetics were there to support this). I was given the option to induce around 37 weeks or schedule a Csection closer to term. I opted for the Csection. I had observed a ton of deliveries during a college internship…. Csections, vaginal, epidurals, no epidurals, first babies, third babies, twins, etc. While the competitive part of me ached a bit I was ok with the more predictable approach. My son was 9 lbs at 39 weeks. I never experienced a contraction (not even a Braxton hicks). He never moved down. My cervix never dilated or effaced. I didn’t experience any part of labor whatsoever. My son’s shoulders and belly had measured off the charts during ultrasounds and as the doctors argued over extending the incision (I had doctors laying on top of me pushing him out and a vacuum used) I felt like I had made the right decision. When it came time to deliver my daughter (baby #2), who was a very normal 7 pounder, I did a repeat Csection.
Now when I share stories of labor with friends I feel very boring (which is ok). I have no battle wounds or traumas to share. No triumphant moment where I pushed them out. I never had that moment where my water broke and we rushed to the hospital. I never had to breathe through the pain and swear at my husband for inpregnating me. No one ever held my legs up as I heroically pushed. I was in and out of the hospital with very easy recoveries. With my daughter I only stayed 30 hours, and my doctor even removed some excess saggy skin for me (score!). In the end though that is just the story of how I became a mother. I have 2 beautiful HEALTHY children which is the ultimate goal. While part of me is curious what the experience would have been like to conquer a vaginal delivery I have no regrets. I’m still a strong, successful woman and mother! I have the utmost respect for all methods of child birth and am happy for mom’s when it goes the way they had hoped. However your story turns out, it is always a special one of how your child came into the world 🙂
Oh my goodness, Katie! What a crazy experience. It sounds like you totally feel all my feels with having two cesareans, but you are totally right: having two healthy children is all that matters! I am especially cognizant of that working in pediatrics– in my mind 99% of children have disabilities. Also, how interesting that your second babe was such a lightweight:) BUT, you definitely have battle wounds to share! Cesarean scars are no joke! Thanks so much for reading and sharing your story!!
Thanks for sharing your experience of making the difficult decision
of whether to try for a VBAC (now known as Trial of Labor after Cesarean or
TOLAC), or to schedule a cesarean birth. I am a Lamaze Certified Childbirth
Educator and former labor and delivery nurse, and I want to assure you that many,
many women also struggle with this decision.
With a cesarean birth rate of roughly 30%, you are not alone!
Much to your credit, you have clearly educated yourself
about risks and benefits of both options. You have selected your obstetrician
with care, and have formed what seems like a trusting relationship with a
provider who encourages shared decision making. Your thoughts and beliefs are
important and should be respected by your caregivers. You have acknowledged disappointment
in having a cesarean that came after a long labor and the wish not to repeat
that disappointment. In my mind, you are a rock star for making a mindful,
informed, and shared decision.
Now, what else can you do to ensure that your baby’s birth
is safe, healthy, and fulfilling? Get as much rest as you can before your
birth. You don’t have to be asleep to rest! Drill down on how long you need to refrain
from eating or drinking fluids prior to your surgery. The American College of
Obstetricians and Gynecologists recommends no solid foods from six to eight
hours before a cesarean, but permits clear fluids up to two hours before
anesthesia. Going for longer periods of time without eating or drinking during
pregnancy is very uncomfortable. To that end, also try to schedule your birth
very early in the morning before the operating room schedule is disrupted by
unplanned surgeries. Ask ahead of your surgery if your Obstetrician supports
delaying cord clamping which can increase your infant’s iron stores.
Once in the operating room (OR), ask people to introduce
themselves to you and your support team. Prior to your admission, find out how
many support people can be with you in the OR. Some hospitals limit this to one
person only. What role do you want your labor support partner/partners to play
before, during, and after your baby’s birth? Maybe hold your hand, help you listen
to relaxing music, or place a dab of essential oil on his/her wrist for you to
counteract OR smells? Perhaps your support person could also massage your
shoulders, and whisper loving, encouraging words to you?
Be sure to ask for warm blankets if you are chilly. ORs are intentionally
kept cool not for infection control as commonly believed, but to keep your care
providers comfortable. In fact being cold can negatively impact your healing.
This is probably the most important of all— Request for your
baby to be placed skin-to-skin immediately after delivery. Your warm body is a
perfect place for you and baby to begin the interactive magic that promotes hormonal
changes that facilitate breastfeeding, a loving maternal/baby bond, and
maternal postpartum recovery. Your support partner can also help promote this
closeness if you are feeling drowsy or nauseated. Not all hospitals encourage
immediate skin to skin, so check ahead of time and if your hospital doesn’t
promote this best practice, find one that does. No interruptions allowed! The
weight can wait as can other “mandatory” newborn procedures. Most can be done
with baby skin-to-skin, anyway. Keep your baby very close to you throughout
your surgical repair and in the hours and days after birth.
Accept help. Yes, you are an experienced mom and you have
done this before, but now you have an older child who will also crave your
attention and love. So, line up friends, family, and perhaps a postpartum doula
to help you devote yourself to rest, recovery, and caring for your baby after
birth.
Again, thanks for sharing this common dilemma and how you
came to a decision. Very best wishes for a beautiful birth experience!
Thank you for the great and thorough tips!