Vaginal Birth after Caesarean
by Alyssa Delle Palme
During my first pregnancy, my natural, drug-free birth plan flew out the window when I was diagnosed with placenta previa. It’s a condition in which the placenta grows in the lowest part of the uterus and covers the opening to the cervix. Placenta previa can be deadly to both the mother and baby because it may cause severe bleeding. At my obstetrician’s office, my heart sank when I was told a caesarean section was medically necessary. Although I was immensely grateful for the surgeons who not only detected the dangerous condition, but also had the expertise to deliver my son, Henry, safely, I also felt cheated. I had a difficult time coming to terms with the fact that I did not deliver my baby the way I had always dreamed.
If a caesarean feels like a loss, it is, says Jennifer Gillean, Ottawa chapter leader of the International Cesarean Awareness Network (ICAN). “You can be both thankful for your baby’s good health and sad, mad or confused at what came up before, during and after your baby’s birth.”
Jennifer encourages caesarean moms who are mourning the loss of a vaginal birth to share their experiences. “Talk about it with your partner, other women who have had a caesarean, a birth-story listener or a counsellor. Recognize that the way you feel about your child’s birth will change over time, and be kind to yourself in the meantime.”
FYI: A caesarean section, also called a caesarean or C-section, is an operation in which a baby is delivered through a surgical opening in the lower belly instead of the vagina.
When I found out I was pregnant with my second child, I was determined to have a vaginal birth after caesarean (VBAC). I read every VBAC book I could get my hands on, joined online support groups and even hired a doula. My midwifery group supported my decision, but it was their policy that I have a consultation with an obstetrician to review the risks of a VBAC and a repeat caesarean.
During my appointment with the obstetrician, I learned the risks of a repeat C-section include surgery-related problems such as infections, blood clots and injuries to the bowel or bladder. Meanwhile, the big concern with a VBAC is a uterine rupture. This occurs when the wall of the uterus splits during labour and it usually happens along the scar of a previous caesarean. According to the Association of Ontario Midwives, a uterine rupture happens in about 0.5 per cent of all VBAC labours.
The obstetrician reviewing my case decided I was an excellent VBAC candidate, but wanted to go ahead and schedule a repeat caesarean for 40 weeks if I did not go into labour naturally. This didn’t sit well with me because it is considered normal for women to go past their due date. I trusted my body and felt the need to assume more responsibility for the birth of my baby because I didn’t want to end up with an “unesscesarean.” After consulting with my midwife, we both agreed the obstetrician was not VBAC-friendly and I decided to seek a second opinion. I found a new doctor who was more supportive and didn’t routinely schedule a repeat caesarean before 42 weeks.
January 30, 2015, after 23 hours of labour, I had a successful VBAC. It was a euphoric moment when the doctor handed me my healthy 10-pound baby girl right away for skin-to-skin contact. I did it! Rosemary June’s birth was an immensely healing and empowering experience. Fellow VBAC mother Johanna Eleanor says her experience was also transformative.
” I felt so proud of what we had done (baby and I), and was in wonder at how nature could take its course the way it had. The best part of having a VBAC was the instant rush of hormones that came over me after my daughter was born. The recovery was easier too.”
As with any aspect of childbirth, VBAC and repeat caesarean each have their own benefits. Mother-of-two Karine Botchar of Rockland says she enjoyed her repeat caesarean birth.
“This time, I wasn’t exhausted from 30 hours of labour prior to the surgery. The surgeon talked to my husband and me throughout the entire procedure and he even cracked some jokes!”
Ottawa mother Danielle Woodland says her first pregnancy ended in an emergency caesarean after a traumatizing labour and the idea of a VBAC gave her anxiety. “For me, a repeat caesarean was comforting. The best part was knowing exactly when my baby would arrive. However, I do feel judged for having had a repeat caesarean birth and I often feel the need to defend my educated decision.”
According to the Canadian Institute for Health Information, the national caesarean rate was 27.2 per cent in 2012, up from 18.7 per cent in 1997. As Ontario hospitals strive to cut caesarean rates, I believe every woman should have the opportunity to carefully weigh the benefits and risks of a repeat caesarean versus VBAC, and to be supported in the decision she feels is right for her and her baby. In fact, the Ottawa Birth and Wellness Centre, at 2260 Walkley Road, has lifted its restrictions on VBAC and is now accepting VBAC clients.
Mothers looking for a non-judgmental place to share their feelings and make sense of a traumatic birth experience can attend a local ICAN meeting. It provides a supportive opportunity for women who have had a caesarean or a VBAC to listen and share their experiences with others. The ICAN Ottawa chapter meets the third Wednesday of each month from 7 to 9:30 p.m. at the Ottawa Integrative Health Centre on Carling Avenue at Holland.