Hooray for VBACS!

My friend and fellow Labor and Delivery nurse, Courtney, sent me this link about the American College of Obstetricians and Gynecologist rewriting an older policy that in part has led to 1 in 3 babies being born via Cesarean. The World Health Organization recommends between 5 and 10% is optimal. The National Institute for Health strongly urged ACOG to reverse their stance on Vaginal Birth After Cesarean (VBAC) because 1/3 of hospitals would not allow them and 1/2 off all OBs would not allow them.
I was pregnant at the height of the original policy ACOG wrote, making VBACs seem very dangerous. I was encourage to have a repeat Cesarean with Karlie because at that time the risk of uterine rupture, which is less than 1%, was thought to be too high. As a labor and delivery nurse and as a woman, I wanted nothing more than to experience birth and not have another painful recovery from a Cesarean.

However, just 6 months before Karlie was due, one of our most beloved OBs lost her baby due to a uterine rupture while attempting a VBAC. After being on bed rest for 5 weeks with Karlie and knowing a doctor that this had happened to and my own OB strongly recommending a repeat Cesarean, I had one. It seemed the best option at the time and I resigned myself that I would never have the experience of a vaginal birth.
Working on the labor deck, you come to know all the OBs and get to pick the best. I had high risk pregnancies, which allowed me to see Maternal Fetal Medicine OBs. The best of the best. Dr. Gallan saw me for all the babies and tried to arrange to deliver each of them. That is another story. :0)

At one appointment I saw a different MFM and she asked me what my plans for delivery were. I was puzzled. She then told me about the possibility of having a VBAC. I thought she had lost her mind! A VBAC after 2 Cesareans! That was like third world medicine. She told me that under the ACOG guidelines, you could VBAC2 at a hospital like ours with an OB constantly available for an emergency delivery. She had planted a seed.
I devoured every piece of literature available on VBAC2. I read everything I could about the signs of uterine rupture and what factors increased it. After months of research and discussing it with Max over and over and over. We agreed that under certain conditions, I would attempt it. Those factors were that I would go into labor naturally, not use pitocin and delay and epidural as long as possible. When I told my fellow nurses my plans, they told me I was insane.
My water broke after working an 12 hour over night shift. I had not slept in 24 hours. Not the best way to start your "risky" VBAC. We waited and waited for labor to start. 12 hours later, we had to decide to do a Cesarean or start pitocin for the risk of infection. I just could not give up on a vaginal birth. So we talked it over extensively with my doc and agreed to do only low dose pitocin. But he really wanted me to consider having the epidural early just in case we needed to rush to the operating room. I really wanted to experience labor. So stubborn. After a few hours of contractions with pitocin, I was fully ready to accept the docs recommendation for an epidural!
As we waited for things to progress, Max and I watched Kaitlin's heart rate closely for any signs of something going wrong. Finally it was time to push. I prayed that my uterus would hold up. I had the most amazing birth experience and will be forever grateful that I was able to birth one of my babies. It is truly a spiritual moment, watching a life come into the world. I can't articulate how different it is to give birth compared to being delivered.

It was such a huge deal just 4 years ago, that when I returned to work, I had nurses and doctors from the postpartum and NICU asking me if I was the one who VBACed after two?! One doctor told me I was a legend on the floor and that I gave her hope to try for a VBAC2. I hope women across the country will now have the opportunity to attempt a VBAC without feeling like they are compromising themselves or their babies.


Courtney said...

Yes! I agree, there truly is no other experience like it. I am so glad you had the chance to VBAC. Our hospital is not currently doing VBACs (due to an anethesia and OR issue), but the OBs are pushing for them. It's an ongoing debate.
BTW, love your pics. Karlie looks so little and love her pixie hair.

Jessica said...

You know how near and dear to my heart this subject is since I have been blessed with 3 successful VBACs. This post definitely brought tears to my eyes!