ICAN! Not your typical day in the life of a pregnant woman.

(Acronym guide below if you are confused.)

A little backstory—I had a C-section with my firstborn, which I now believe to have been unnecessary.  I was not very well informed.  I don’t recall having any friends who were pregnant at the time to influence me, and I was so afraid of the pain of labor and delivery that for some reason I thought it would be a good idea to just ignore it until I had to do it!  I really loved my doctor, but I’ve learned since that you should always ask questions about the risks and benefits of what you are being advised to do.  Had I done that, I’m sure she would have let me labor longer, and I might have progressed farther than 8 cm.

After the C-section, when recovery was more painful and difficult than I could have imagined, I started wondering what would have happened if I hadn’t let fear cloud my judgment.   At first I thought there was no way I’d every want to attempt a VBAC* if there was a chance I would just have to have a C-section again.  Then I came upon a concept called the cascade of intervention.  It goes something like this: induction, Pitocin, epidural (to manage the pain of Pitocin contractions), numbing your body’s labor instincts because of epidural and restricted movement impedes baby’s descent, more Pitocin, less progress, C-section!  It sounded a little too familiar.   I came to the conclusion that I would have had a MUCH better chance of delivering naturally had I said no to Pitocin, induction, and epidural.  But that didn’t change my fear of pain.

Gradually I came around to the idea of doing birth completely naturally with no pain medication.  I wanted my best shot at having a VBAC.  I researched midwives and OBs.  We decided that homebirth was not for us (though I love the idea and cheer for those who do it!).  A birth center seemed nice, but an added expense that insurance probably wouldn’t cover.  The risks of VBAC, though quite small percentages, made us feel more comfortable with a hospital setting.  I found the world of Certified Nurse Midwifery. Nurses take a masters level degree in midwifery and are able to prescribe and treat much like a nurse practitioner.  They often can’t take high-risk pregnancies and can’t perform surgery.  The advantage, at least in our situation, is that the CNM is with you through the whole labor and delivery, unlike an OB doc who will check in on you periodically and can be attending many births at the same time.  We interviewed one CNM and something she said at the end put this picture in my mind that I would be in good hands on a very painful day of my life! 

So we signed on.  I had so many questions and concerns over the last eight months, and my CNM gave me great confidence.  About halfway through, I looked into Bradley Method classes to help us be even more prepared to deal with unexpected turns in labor.  I found and was encouraged to take an 8-week childbirth prep class through Well-Rounded Maternity.  We were the only second timers in the class, but it was well worth the information and confidence it gave us. 

Then came the bad news.  I guess I was told that to have a VBAC at our hospital I would be required to have a pelvimetry x-ray and ultrasound to compare the size of the baby to the size of my pelvis.  I don’t remember.  We reluctantly agreed to do it despite my concerns about radiation.  It didn’t seem worth it to switch hospitals at 32ish weeks when I realized we had to go through with it.   I thought we’d go along with it and insist on a trial of labor whatever the results.  My class had taught me that the only way to truly prove a pelvis was too narrow was a TOL. 

We had the x-ray and ultrasound on Friday at 38 weeks.  The x-ray suggested that I have a small mid-pelvic measurement.  The ultrasound (which have at least a 2lb margin of error) suggested a large baby with a larger head.  This would have been discouraging news.  It became heartbreaking news when we were told that afternoon that there was no way the hospital would allow us a TOLAC with those measurements!  I found myself facing a mandatory repeat C-section after all my incredibly hard work, money invested, and hours of driving to classes and appointments which were all an hour round trip, Stunned, we agreed to set up the C-section for this coming Friday.  I had a nagging feeling that it wasn’t right, but who is going to switch doctors at 38 weeks? (Hint: that would be me.)

We prayed, talked, and even though I knew I would make myself crazy, I started researching pelvimetry and VBAC stats.  On Sunday morning I woke up just feeling like giving in to the c-section was the WRONG decision. 

I’d talked to a nurse turned doula turned midwife in training (we’ll call her S).  When she heard about my situation, she got on the phone with a doctor friend to find out what the deal was with this pelvimetry thing.  I called S back and gave her the details.  I also called my class instructor, C, who recommended I try getting another opinion and seeing if a doctor would take me on at 38 weeks.  C and S referred me to the SAME doctor who does tons of VBACs.  S told me that her friend said pelvimetry was an outdated practice and that hospitals don’t even make people do them anymore.  They had no idea why mine wanted it, let alone would forbid my VBAC because of it.  (The pelvis changes in labor; so do babies’ heads.)  Thanks to S and her doctor-friend’s help, I got in to see Dr. W (the VBAC guy) TODAY!!!! 

Dr. W was incredibly supportive and helpful.  He is willing to take me as a patient even if I go into labor right now.  He said pelvimetry went out of date in the 1950s and he can’t believe a hospital in the area would still require it.  He answered all of our questions.  The only downside is that I won’t be able to eat once I go to the hospital, whereas I could have at my original hospital.  (Here’s to hoping for one of those labors that isn’t three or four days long!)  I might meet with S’s friend Dr. K tomorrow.  She’s a family practice doctor who can do VBACs also as long as Dr. W signs off.  She also agreed to take me as a patient even without meeting with me yet! 

No one can guarantee a 100% risk free VBAC, but the same is true of C-section--especially a repeat C-section.  When I’ve compared the risks of the two, I am much more comfortable with VBAC risks.  Even considering that some VBACs still lead to C-section, the TOL alone has important benefits for the baby and me.   I’m really sad that I have to part ways with my CNM.  She was great, and in my perfect world, I would still want to VBAC with her. 

I am completely amazed at how this day has turned out.  C has been a wonderful support.  S went to bat for me, and I haven’t even met her in person yet.  I prayed that I’d be able to get an answer about whether or not to go ahead with the C-section by Wednesday.  It’s still Monday and I had my answer by 6:00.  God is faithful.  SDG.

*Acronyms guide:

ICAN: International Cesarean Awareness Network http://ican-online.org/

VBAC: Vaginal Birth After Cesarean

CNM: Certified Nurse Midwife

TOL: Trial of Labor

TOLAC: Trial of Labor After Cesarean

ERC: Elective Repeat Cesarean

SDG: Soli Deo Gloria (Glory to God alone, made famous by J.S. Bach who signed SDG after all his compositions)