To VBAC or Not to VBAC...

There is so much controversy surrounding VBAC (Vaginal Birth After Cesarean) lately.  Cesareans are the #1 most frequently performed surgical procedure in the US, and the cost of surgical intervention is more than twice the cost for a vaginal birth in the hospital.  As of 2010, the C/S rate in the United States is at 32 percent nationally with a variance of 22-38% on a state by state basis, the rates having risen as much as 50% in the last 10 years.  The World Health Organisation states that a safe and valid number should be somewhere around 15%. The maternal mortality rate as of 2011 is 12.7% ranking the US 50th world wide, a number which has doubled in the last 25 years.  The infant mortality rate in the US is 7%, ranking the US 34th worldwide, and this number has risen in the last decade.  The premature birth rate in the United States is 12% which ranks the United States a whopping 131st world wide.  C-section rates are higher among the poor and ethnic minority populations, mostly because they don't know better.  What these numbers prove is that a rising Cesarean rate is not improving the lives of mothers and babies, actually quite the opposite appears to be the case.  It is also violent and damaging to a women's psyche.  Along with our soaring rate of intervention in birth, including the ridiculous rate of surgical intervention, postpartum depression and psychosis has become an epidemic.

Fewer and fewer providers are allowing trials of labor (TOL) for women who have previously had a surgical birth.  The American College of Obstetriticians and Gynecologists (ACOG) themselves endorses TOL and VBAC, stating that the risks of repeat surgery are greater than the risks of complications occurring because of the uterine scar, but again and again I hear from women who cannot find providers who will all them to attempt a vaginal birth in the hospital.  Sadly, even midwives are becoming rigid about this.  Many nurse midwives practicing in the hospital cannot or will not encourage or assist women with VBACs, especially if they have had more than one Cesarean   I believe in homebirth and ultimately unassisted birth, I believe in the strength and power of women, and the body's miraculous ability to heal, but I am sad and frustrated that women are being FORCED to choose between homebirths and surgery, when they may not feel 100% safe at home.  Of course I deeply believe that most women can give birth vaginally, and that most women experiencing low risk pregnancies CAN have their babies at home, but not everyone WANTS to have their baby at home.  Homebirth has to be an option that parents come to on their own, rather than it being forced upon them.

If you injure your back or blow out your knee, you are urged to take the necessary steps to encourage healing, and eventually you are expected to use those parts again in the proper way. If you have heart surgery, brain surgery, bowel surgery, we don't just automatically assume that these organs are now defective and stop trying to live, no, we are encouraged to create healthy attitudes and lifestyles and HEAL.  If the body can heal a back or knee or brain or heart, and those parts can be used again, for walking, twisting, lifting, thinking, pumping etc. it stands to reason that the uterine muscle will work properly too.  We heal.  We just do.  It makes sense for surgeons who are performing Cesareans to be diligent in closing the incision with the  expectation that the organ will heal and be able to be used again, in a normal fashion.  Am I naive in thinking that this should be true?

So the question really is how committed are you to birthing your baby vaginally?  Are you willing to stand up for yourself in the face of adversity, invest in a birth team who are going to support you and believe in you?  Are you willing to say NO?  Studies show that VBAC is safer for both mother and baby.  The long term effects of natural birth over interventive birth, and specifically surgical birth are overwhelming.  We do what we do, we breathe, we make an intricate chemical exchange in our lungs that is amazing.  We eat, and think, and breathe, and pump and filter and gestate and give birth.  It is what we do.

The chemical actions that occurs in mother and baby during pregnancy and birth happen the way they do for a reason.  There is rarely an accident or malfunction that isn't caused by interfering.  Normal birth happens.  It happens when you are young, old, fat, thin, happy, sad, tall, short, married or not.  It happens.  It happens best when it is left alone. Homebirth is a safe option for women experiencing an uncomplicated pregnancy.  VBAC is as safe as running a marathon on a knee that has been surgically repaired.  The only difference is that the marathon runner gets patted on the back for pushing through adversity and overcoming the dysfunction.

To the doctors I say; women experiencing labor with a scar on their uterus need time.  Blown out knees may heal quickly, but learning to walk, and run on it takes time to figure out.   Stop rushing women into surgery.  Stop supporting a broken health care system by damaging the uterus's of more than a third of women, you cannot honestly believe that one out of 3 women are defective.  Stop spending so much time convincing yourselves and the women who trust you that they are broken.  Women, stop believing you are broken. Our doctors and surgeons can save our lives, and that of our babies, when things go awry. However, just like we don't rush out and get a colostomy, the first time one might get constipated, women should not be having their uterus's cut unless there is a true indication for surgery.  Fear should NEVER be an indication for surgery.