To V or not to V, that is the question

And by V, I mean vbac (vaginal birth after cesarean). I've had three of them and here are my experiences.

First of all, let's start at the very beginning. My "Wishes for Childbirth" with DS1 included:

I would like to avoid induction unless it is medically necessary
If my water breaks and baby is fine, I prefer to hold off induction
If I go over due and baby and I are fine, I prefer not to be induced
If labor is not progressing, please break water before using drugs to augment

I don't know what happened there, but absolutely NONE of those things happened. And it's partially my fault

One day before my EDD

Ever heard of the Cascade of Interventions? This is a pretty good visual

Source: The Birthing Site

 This was my cascade

In a nutshell that tells the story of my first birth!

When the decision was (mutually) made to do the c-section, my Dr said he would do a low transverse cut so that I could try for a vbac in the future. I asked him if he did those and he said yes.

Thirteen months later when I got pregnant with DS2 I called to make a Dr's appointment and found out that the hospital where I delivered DS1 no longer allowed vbac. I would either have to switch Dr's or go for repeat surgery. My Dr wanted to have a consultation with me, so I scheduled that.

I was told that I had a 50-70% of having a successful vbac. Overall the percentages were 60-80%, but my Dr thought given my history that I would be on the lower end. He said that I could show up ready to push and get my vbac that way, but he didn't recommend it. I decided to interview other doctors and started with the one that my sister-in-law had a successful vbac with.

He said that they encourage vbacs and while they don't normally induce, there are circumstances where they will. Which is fine, I don't really want to be induced. He was much more optimistic about my chances and when I asked him if there were restrictions like me having to dilate 1 cm per hour he looked at me like that was the more absurd thing and said no way would they do that. I decided to switch providers. My decision to attempt vbac was a no-brainer for me; I did NOT want to recover from surgery with a newborn and a toddler. I figured that if my attempts failed at least I gave it my best shot.

I asked later if there was anything that I could do to increase my chances and he said "grow a smaller baby (DS1 was 9.5 pounds) and go into labor on your own" and that women who are sexually active go into labor on average 1-1.5 weeks earlier than those that aren't.

At about 34 weeks we discussed breaking my water if my cervix was favorable at 39 weeks to reduce that chance of a big baby, but I was told that any inductions increases my risk of a repeat c-section. We scheduled the induction for 3/12 (baby was due on the 19th according to them, but the 14th according to me... and the ultrasound, I might add).

At my 37 weeks appt, I was checked and found that I was 3 cm, 70% and -1 station. I was THRILLED with this news because I never made it past -2 station with DS1. The Dr told me I was certainly favorable for induction, but she didn't think I would last that long.

38 weeks

38 week appt showed no change in my cervix, but the ultrasound estimated a 7 pound 3 ounce baby. I asked about being induced sooner (I was so done being pregnant), but they said it is still better if I go on my own (which I now appreciate).

On March 4th I started having a lot of consistent cramping. Since I didn't know what non-Pitocin contractions felt like and I was "high risk" my OB had me come in to be checked. I hadn't made any progress and was quite depressed at that news. I now know there is no mistaking real contractions!

Four days later I woke up with contractions that kept me from sleeping. After about an hour I got in the tub and timed them at 8 minutes apart and then 6 minutes apart. I called the on-call OB and because of my history they didn't want me to wait any longer before coming in. SO excited! The contractions slowed down in the car, but were still painful. By the time they got me in triage and on the bed my contractions had stopped. No progress. SO discouraged! We walked for an hour and I felt lots of pressure and some contractions, but once I was hooked up they stopped. So they sent me home.

I now know that my body takes a while to get used to each new situation and it is not uncommon at all to slow down or stop labor in unfamiliar situations, but it was so hard to be sent home.

That night the contractions picked up again, this time for real! DS2's birth story can be read here. I don't think I put it in his story, but I did have to sign a scary vbac consent form that had every imaginable complication on it. I wasn't worried about my scar because I have always healed well. I think one of the times that I did to succeed in my vbac (as opposed to things out of my control like the smaller baby and spontaneous labor) was not get my epidural until labor was well established and I was 5 cm. Of course, at that time, if I had been given the choice I would've gotten it as soon as I got to the hospital!

Fast forward 15 months and I was expecting again. At my first OB appt I was told that my chances of having another vbac were even better than they were with the first one and that in his 20 years of delivering babies he has only had one uterine rupture. I wasn't nervous about DS3's birth at all, I knew I could do it. So instead of focusing on vbac, I focused on trying to go natural.

37 weeks 5 days, 2 days before baby was born

His story can be read here. Again, there were a few things I didn't mention in that. I had to sign the scary consent form again, but was expecting that. Once I was standing up and the nurse was adjusting my monitors. She had her face inches from my scar and commented on how nice it looked. "Why, thank you" lol After the delivery, the OB informed me that he checked my scar internally and everything felt good. It wasn't until later that I realized he stuck his entire hand up me and into my uterus to feel my scar! I must admit I felt a little violated by that and was pretty ticked when I later found out that it's not even evidence-based medicine!

When I was pregnant with my fourth baby I decided to explore my other options including using a midwife and having a water birth. Home birth was not an option for us for many reasons, and the freestanding birth center couldn't accept vbac clients. There was one midwifery group that practiced at a hospital that did water birth, but not for vbacs. I send the following letter to all the midwives...

I recently called your practice to see if there were any midwives that are supportive of water birth. I was thrilled to hear that pretty much the whole group did them. I was quickly discouraged when I heard that water births are not offered to VBAC patients. I have had two problem-free VBACs since my C-section in 2002 and do not feel like my scar should prevent me from having the birth of my dreams. Is there any way to make an exception to this rule?

I was actually surprised to get a phone call from one of the midwives not much later and she told me that they discussed my situation as a group but still weren't comfortable offering me that option. So I decided to stay with the practice I had my last two babies with and just switch to the midwives there.

Timeline

That made my labor better in many ways; the nurses would use the Doppler to check the baby while I was still in the tub, the midwife would actually check my cervix in the tub, and I never had to sign the stupid consent form. They were also MUCH more supportive of natural birth, I was never asked to rate my pain (which is another thing that I find annoying and stupid; if I'm in pain and want drugs why do you care what number it is?!) His birth story can be found here.