Saturday, March 6, 2010
Why is VBAC a vital option?
There is a VBAC blog carnival going on right now. As a woman who believes vehemently in access to VBAC, and who has had both a cesarean and a vaginal birth, I wanted to weigh in on the carnival atmosphere.
Read other blog entries here on the International Cesarean Awareness Network!
Vaginal birth after cesarean. Cesarean births, since their invention as an attempt to rescue infants whose mothers had died or were considered beyond help during childbirth as early as the 1500s, have always been considered a last resort because of the risks involved. Gradually, cesarean surgery became safer and safer, particularly with the introduction of aseptic technique, suturing, low transverse incisions, and antibiotics, and is often now considered quite safe.
Surviving the surgery is now no longer of paramount concern because it is so common. Occasionally, women will experience complications from the surgery which devolve and become fatal, but this is so infrequent that most obstetricians would see this at the very most a handful of times in their entire careers. Many never see it at all.
I had a cesarean delivery with my firstborn son in 2003. I had some complications from the spinal anasthesia, but I had no infection, no bleeding, no dangerous issues with my body afterwards. I was grateful that cesarean surgery is so finely tuned, since I had one.
So why is vaginal birth after cesarean a vital option? Because it is protective. Modern obstetrical subculture tends to oppose VBAC on the basis of the increased risk involved in giving birth vaginally after major uterine surgery. It is true that a woman who has experienced a previous cesarean has a greater risk of having her uterus rupture than a woman who has never had a previous cesarean. But it is not true that cesarean surgery is safer for that woman than vaginal birth. Repeat cesareans are higher risk than initial cesareans, and this is well documented and acknowledged in obstetrics. Many risks associated with cesareans don't develop until subsequent pregnancies: higher rates of placental accretia and placenta previa, higher rates of infertility, higher rates of adhesions, rupture, hemorrhage, ICU admissions post operatively, hystorectomy, and maternal death. Every repeat cesarean a woman has increases all these risks in subsequent pregnancies.
Many women in our culture now desire to have just two children, which makes these risks minimal, but the desire to have two children is not universal. For women who want more than two babies, the prospect of cesarean surgery is more dire.
Encouraging VBAC protects women against these risks.
Encouraging VBAC is also protective of babies. Babies do not develop at a universal rate, and if left alone to birth physiologically, each individual child is born when it is ready. There is no way to measure an individual baby's exact date of 'mature enough,' except to wait until labour begins on its own. Scheduling subsequent cesareans is guesswork which doesn't always guess accurately, which results in babies with higher rates of transient tachypnea, premature birth, or other health problems.
A cesarean surgery bypasses all of the physiological stages of vaginal birth, a complex interplay of chemical and neuromuscular and hormonal factors that we have only begun to understand. We are highly adaptive creatures, but there are forces at work in the birth process which have the potential to affect women, babies, families, and society at large in ways we have yet to discover or understand.
Women who have surgical births are at higher risk of breastfeeding difficulties. Babies are necessarily exposed to drugs during surgical birth, which can suppress a newborn's instinctive breastfeeding behaviours and affect a baby's suck for up to a month afterwards. Women are at increased risk of developing nipple trauma and poor latch from a weak suck or uncoordinated, medicated baby. Inability to initiate breastfeeding puts infants at increased risk of morbid illness as infants and as children, and puts women at increased risk of developing future reproductive and breast cancers, osteoperosis, and other diseases whose frequency is reduced in women who breastfed.
Women who deliver via cesarean have a slightly increased risk of developing postpartum depression, and women who do not breastfeed are well documented to have higher incidences of postpartum depression or mood disorders, which some researchers have speculated to be attributable to the body's perception of an infant death when a woman's body gives birth but does not go on to breastfeed a baby.
VBAC is a vital option for women's health and reproductive rights, because it offers a safe and effective way for her to avoid the above risks involved in cesarean births for her and her baby. Attempted VBAC success rates vary according to geography and birth support and birth attendants and reasons for the original cesarean, but the success rate is recorded as anywhere from 60 to 90 percent. If 60 to 90 percent of women can successfully perform a protective physiological function: normal, vaginal birth--why shouldn't they be encouraged to do so? Why are they being discouraged or even outright banned from doing so en masse? I know ONE woman who was enthusiastically ecouraged by her obstetrician to have a vaginal birth after a cesarean. That was me. I know many women who were discouraged, threatened, bullied, and yes, some even legislated by the courts into having repeat cesareans instead of attempting VBAC.
Another important factor of VBACs is the intellectual impact on women. Women who have cesareans have their babies delivered from them, rather than actively giving birth. These women often overtly or subtly recieve and internalize the message that their bodies are broken, inadequate, weak, or unsuitable for the task of giving birth. Disempowered and delivered OF is not the ideal attitude with which to embark upon the complex and difficult human task of parenting. Many, many women move beyond this state of mind to become empowered and healthy parents, because the human creature is highly adaptable, but it is beneficial for all if the birth process is an empowering one, rather than something women have to move beyond in order to become empowered parents.
In these cases, vaginal birth after cesaran is not simply protective, but redemptive. Women can reclaim a belief in their bodies' ability to give birth in a powerful and self affirming way by giving birth vaginally after a previous cesarean. Birth is beautiful and powerful, and it moves all of us who witness it. It moves the woman who gives birth most of all, and fills her with joy, love, and a sense of strength and trust in herself. This is vital! This is why VBAC is such a vital and powerful option, which should be actively encouraged by all who work with birthing women.