I’ve been meaning to document how plans are coming together for this birth but it’s difficult to put down on paper for me. I was surprised to hop on to my (finally!) fixed computer and see so many posts up on birth plans and preferences last week. The conversation going back and forth between so many women I respect and I admire was very interesting, especially when there were so many different viewpoints and previous experiences. I haven’t gotten around to commenting yet (sorry! I will), I wanted to write here first before reading and commenting.
A bit of history – with Leopold’s birth, I was induced at 39 weeks because my doc told me I had to deliver by my due date due to hypothyroidism and she suggested doing it sooner since we likely had large baby on our hands who would only be getting bigger. I went in to the hospital to be induced not even a finger tip dilated, after over 24 hrs of cervidil then piticon I was barely a 3, and Leopold was having some heart deceleration through the near constant pit contractions. My doctor suggested that we do a c-section before it becomes an emergency situation but it would likely become one over night. We went with her suggestion, exhausted and afraid. Leopold was born (9 pounds 5 oz, 22 inches), taken from me to be cleaned as I was stitched up, I went to recovery. An hour or two later I got to hold and breastfeed for the first time at which point he stopped breathing and was taken from me again for overnight observation for about 8 hours. it was not a great experience.
I was unhappy with my treatment during the delivery and felt I was fear-mongered into both the induction and the c-section by my doctor. With this pregnancy, I went back to my original doctor until around 20 weeks until I got the courage up to make a switch. my birth plan has come quite a way in its development from the start of this pregnancy. I always knew I wanted to attempt a VBAC if possible and safe for us to do so, but my hopes were quickly dashed by my original OB. I voiced my interest in pursing VBAC this time and her response was that she would allow it if I went into labor on my own before 40 weeks and if labor progressed normally. Then made a few comments that it was unlikely that I would have a smaller baby the second time around and Leopold’s size was the main issue with him not being born vaginally and she didn’t see the situation changing this time around.
I was deflated but un-surprised by her response. I went on a mission to find a more VBAC-friendly doc and a doctor who was willing to let me go past my due date. I found two doctors who were great candidates, both told me that there was no way to tell if my son was “too large” for me given that I only made it to 3 centimeters dilation before the c-section and never made it to active labor. In addition, both told me that my doctor’s insistence on inducing me before 40 weeks because of my well-controlled hypothyroidism was unnecessary.
I became more and more upset with the care I received with Leopold’s pregnancy and birth. I talked to other women who went to my doctor and every single one was induced before or on their due dates, most without a medical reason. Their inductions went well though and they had no issue with the care they received. It frustrated me that I was just now figuring out that my doctor treated all pregnancies the same, induced more than was necessary (in my opinion). I wanted a doctor who was willing to go with the flow a bit more than she was, give a woman’s body a chance to start labor rather than force it. I also wanted a doctor who was okay with a woman laboring longer than 24 hours (or whatever they deem is “normal” labor) if baby and mom are doing fine, and I knew now that we didn’t have the same birthing philosophy. I knew it was time to move on.
It took me some time to get up the courage to look for other doctors. Given my history of infertility and loss, at first I wasn’t sure if this baby was going to stick, then I just didn’t want to deal with the pain that is shopping around for a better doctor. I knew I deserved better care and better treatment than I received at the old doctor’s office. I deserve the best chance at the birth I desire and a doctor who won’t try to bully or scare me into a repeat c-section every chance she gets. Yes, I am okay with a c-section if it becomes medically necessary, but I don’t trust my old doctor’s view during a VBAC on when one would become necessary. I question whether it was necessary for Leopold’s birth and I know now that the induction was definitely not necessary. I don’t know if I would have had more time if I would have been able to birth him vaginally, but I know that I wasn’t given much of a chance.
This time, I feel more empowered already. Even though the odds of success are worse, the stakes seem higher, the risks are scary, I have peace with my plan. I found an awesome a doctor whose vision on birth I love and whose bedside manner is fantastic. I trust his instincts and his opinions and I know that he won’t bully or scare me into anything that isn’t necessary. I trust him to present me with the facts and have an honest and frank discussion about each decision every step of the way.
In addition to the new OB:
- I have a great doula to help me prepare a birth plan, think of all the unforeseen situations that may arise, and will empower both me and my husband to have our voices heard through the birth.
- I’m reading books that help me gain confidence in my body and keep me informed about the risks and the pros of VBAC.
- I’m listening to hypnobabies scripts to help me prepare for labor, build confidence, and help me relax.
- I am seeing an acupuncturist throughout pregnancy who will help me with prepare my body for labor through certain acupuncture points starting at 35 weeks and weekly until labor begins. He also was with me through my IVF cycle, so he’s been a great constant throughout this process and a source of support.
- I’m reading VBAC success stories and lots of books with positive messages on labor and delivery.
I’m in a good place at almost 29 weeks. I am no longer afraid of feeling like having another c-section will take something away from me or all my effort or preparation was in vain like I went into battle and lost. I’m preparing for the best and hoping all goes well, but know if it doesn’t, I’m in good hands and I’ll know I gave it all I got for a VBAC. I was afraid to dare to dream, to put it all out there that if all didn’t go well that I would be devastated. All of this careful preparation though has driven home the fact I know that I am not in control of how or when this baby is born and I am at peace with going along for the ride. My doctor is in no way promising me a VBAC, but is very straightforward with the risks, chances, and rates of success.
I have a plan for a trial of labor – but my body has to start things, and if it doesn’t by 42 weeks or some unforeseen complication arises, a c-section might be suggested by my doctor and if that’s the case, we’ll go with it. I will share my birth plan with my doctor, my doula will help me voice what I want if a c-section is necessary so my baby can stay with me if at all possible.
If I do go into labor on my own, I am supposed to go to the hospital as soon as labor begins. My doctor requires a heplock (IV port) to be accessible and continuous fetal monitoring throughout labor with a VBAC (this can be wireless). I am okay with this. I want to attempt to do things without medication because I want to be able to move with the labor and change positions as necessary to move things along. I also had horrible shaking while the epidural wore off last time. I would love to be able to feel great after delivery and enjoy my baby instead of waiting hours for the meds to wear off before I’m able to walk. If I am not able to cope or if I am unable to relax, I am not opposed to getting an epidural, but I would try many other methods of coping before.
A few facts on VBAC:
- The risk of uterine rupture is around .5%, similar to the risk of first time moms of cord prolapse, shoulder dystocia, and placental abruption.
- The risk quadruples if certain types of induction techniques are used (including cervidil). However, Pitocin can be used if labor has already started and a foley balloon can help get the cervix ripened – both of these techniques are considered safe. (though I hope to avoid all forms of induction if possible!)
- The risk of maternal mortality is very low whether a woman plans a VBAC (0.0038%) or an elective repeat cesarean (0.0134%). (2) Limited evidence suggests that there is a 2.8 – 6.2% risk of infant mortality after a uterine rupture. (So that’s 3% of .5%, a very low risk number overall)
- Repeat c-sections are not without risks. “The most serious cesarean-related complications become more likely as an individual woman has more cesareans. (11) These complications include placental abnormalities such as placenta accreta which carries a 7% maternal mortality rate (12) and a 71% hysterectomy rate. (13) After two cesareans, the risk of accreta is 0.57%, (11) similar to the risk of uterine rupture after one cesarean” (from VBACFacts.com)
With all of the research, doctor questioning, nurse questioning, doula research and reading I’ve done, I am comfortable taking on the risks that come with a VBAC and accept them. I also accept the chance that a repeat cesarean section is in my future. I trust that I’m in good hands and I’ve put my baby’s life in great hands too. We’ll be at a great hospital and monitored constantly, and an anesthesiologist and OB will be on call 24/7 while I’m in labor in case a rupture were to occur they could get the baby out within minutes (though of course I really hope that doesn’t happen).
For now, I continue taking care of myself, this baby, reading, listening to hypnobabies, and hope for the best outcome possible. Carlos and I meet with our doula next Saturday morning to nail down the birth plan. I’m in a good place and excited to see how all this unfolds. I’m already proud of how proactive and empowered I’ve been with making plans for this birth. I don’t expect all to unfold perfectly, but I do expect to be treated well, to be kept informed, and taken care of through it all.