Birthing Again: A VBAC Experience

Birthing Again: A VBAC Experience

By Melissa Aberle-Grasse
Web Exclusive

I lay on my bed in a square of moonlight, resting. Emma, only seven hours old, slept next to me, her hands folded together as if in meditation. Only my heart's pounding--not with anxiety, but with joy and power--broke the calm. Just hours ago, I had birthed this baby. No outside stimuli or interference, just me: the energy and knowledge of my body, and several strong assistants.

That night stands so bright partly because this second birthing was so different from the first. My first baby was born by cesarean section. My husband and I worked with the same midwives for both births and had desired a natural childbirth with the first. In the first case, I believe that the intervention of surgery was wise. The baby clearly had distress in labor and was born, full term, at only five pounds.

When my second baby was conceived, we again longed for a natural childbirth. Despite discouragement from doctors and medical advertisements, I was able to birth vaginally this second child. Three conditions especially undergirded this birth: supportive assistants, a pregnancy of heart and body, and an active birth.

Supportive Assistants
For a woman interested in vaginal birth after cesarean (VBAC), working with a midwife and a supportive partner is critical. Even though medical research favors VBACs, medical practice generally opposes them. Repeat cesarean section deliveries have increased in the US since 1997, after declining somewhat in the 1990s (ACOG, 1996).

I met this reluctance in the supervising doctor of my midwives. " So, you're planning to use the birthing center?" he said. The tone was clearly dubious. An anesthesiologist friend explained the systemic reluctance about VBACs. " When there's a VBAC, we all have to be on call, ready to go, even though we might not be needed--the anesthesiologist, the neurologist, sometimes other specialists…it's a waste of our time."

Yet medical research favors VBAC for most healthy pregnancies. Of course, there are risks associated with a VBAC. But the facts show that, compared to a cesarean section, a vaginal birth involves less relative risk. In a 1999 study of 500,000 deliveries, the risk of a uterine rupture among those who attempted a VBAC was very low: less than .2 percent (OG, 1999). The American College of Obstetrics and Gynecologists recommends that women who have had a cesarean section consider a vaginal birth, with careful consideration of their individual health and risk factors (ACOG, 1998).

So VBAC is a rational option. Perhaps more important, my husband and I found, was the experience of birthing a baby naturally: my bodies' wisdom and energy, our mutual support, and the miraculous process of growth, pain, and new life.

Every couple entering a pregnancy should weigh the options and choose the birthing plan that works for them. For women considering a VBAC, because of the professional resistance, it is especially important to have supportive assistants. A midwife and a close partner at birth are critical. Knowing and asking for what feels strengthening and calming during birthing is key to a healthy labor. I had two assistants, my husband, John, and a midwife, with me through every minute.

"How about some George Winston to listen to?" John asked. It was about six hours into labor; contractions were about seven minutes apart, and fierce. I was still walking, but groaning or shouting with each step.

"No!" I shouted. "I want the drumbeats!"

I squeezed John's hand like it was rubber. (The next day his fingers bruised fingers showed it!) Having a spouse or partner who can support without fear or judgment is essential. In this, John was a rock. He'd seen my belly cut open for the first baby. He believed in this birthing process and was not afraid of my pain.

With fiery drums sounding in the background, I stamped and leaned over a chair, while a midwife massaged my lower back. I spent time in a Jacuzzi, where the midwife massaged my feet, hard.

I can't imagine pregnancy and delivery without a midwife. (The word comes from Old English, where it means "with woman.") My midwives were licensed and worked in consultation with gynecologists; other midwives may be highly skilled but choose to work outside the medical system. Both kinds are trained to support the natural processes of a baby's fetal growth and birth. They believe that these are mysterious and beautifully designed human processes that usually do not require intervention.

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Mandy-Saint Louis Doula

Birth After Cesarean: A Primer for Success

By Diana Korte
Issue 89, July/August 1998

Newborn babyAlthough VBACS--vaginal births after cesarean--have been occurring all over the US in small numbers for most of this century, the medical profession now welcomes them with unprecedented enthusiasm. In 1995 (the latest available year), 35.5 percent of US women who had previously given birth by cesarean had vaginal births subsequently--almost six times the rate of the previous decade.1 And the number of vbacs in this country keeps climbing, pushed upward by some combination of medical research, consumer desire, and insurance company directives.

A mountain of research shows that both babies and their mothers benefit from a subsequent vaginal birth. According to the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Academy of Family Physicians, and midwives everywhere, babies are healthier, mothers have fewer problems, and both go home from the hospital sooner after vaginal births.

Advantages for Babies Born Vaginally:

Babies born vaginally are usually born when they're ready, rather than prematurely by surgery. On average, babies born by cesarean have lower birthweights and have completed fewer weeks of gestation than vaginally born babies, which suggests that many cesareans occur before labor begins.2,3 These babies account for the majority of admissions to high-risk nurseries. Although some of them are born before their due dates because of medical emergencies that threatened their or their mothers' safety, others are probably born too soon because labor was induced or because the cesarean was scheduled ahead of time, according to a miscalculated due date. These problems are less frequent with cesareans performed after labor begins naturally.

Babies born through the birth canal have the benefit of a surge of the hormones called catecholamines, which are essential for survival. These hormones, one of which is adrenaline, are found in much higher levels in vaginally born babies.4,5,6 Catecholamines are secreted by the infant's adrenal glands, which lie atop the kidneys and are released in the baby in high amounts during labor, sometimes changing the . They prepare the infant for survival outside the womb.

Catecholamines help to clear the infant's lungs in preparation for normal breathing, speed up the metabolic rate for quick stabilization, and promote a rich supply of blood to the heart and brain. The catecholamine surge of a vaginally born baby keeps a newborn alert for some time. These hormones also dilate eye pupils, probably in preparation for the "falling in love" bonding that takes place at birth between baby and parents.

Babies born through the birth canal are much more likely to be born with healthy lungs. , sometimes known as hyaline membrane disease, is a condition in which the baby's lungs are not strong enough to get sufficient oxygen to body tissues. This problem, which is aggravated by anesthesia (in particular, general anesthesia) and lower levels of catecholamines, is 20 times more likely to occur in babies born by cesarean prior to the onset of labor.7,8,9,10,11 In addition, these babies are more likely to be on mechanical ventilators in nurseries than infants with other respiratory illnesses.

Babies born vaginally have higher Apgar scores. Of course, it makes sense that a baby in distress that needs to be delivered by cesarean might have a lower Apgar score--especially one born to a woman who had general anesthesia (rarely used) instead of . In a 1995 study of uncomplicated, full-term pregnancies, most babies, regardless of how they were born, did not require nursery stays or breathing support. However, when the 10,871 vaginally born babies were compared to those 538 infants born by because of a too-big baby, a too-small pelvis, or a too-slow labor, there were marked differences. The surgically born babies were more likely to need intermediate or intensive care at birth, along with respiratory support, and were more likely to have one-minute Apgar scores of less than 4.12

Babies born vaginally can enjoy early, frequent contact with their mothers. A woman who has a cesarean often gets only a glimpse of her baby immediately after birth. Sometimes a baby is taken away quickly to be checked, partially because he or she may have a higher risk for a number of newborn problems. The mother will remain in the operating room to have her incision sewn up, and then move on to a surgical recovery area. A woman who gives birth vaginally, on the other hand, can eat, drink, and move around as well as feed and care for her newborn immediately, if she so desires. When a VBAC mom takes her baby home, she's much more likely to be able to give her newborn more attention, because she is not recovering from surgery and does not have the accompanying postoperative pain.

Babies born vaginally are much more likely to be breastfed and to be nursed for a longer time span. The first days of a baby's life are critical to breastfeeding success, and successful breastfeeding is easiest when the early stimulation of the breast created by the baby's sucking produces a bountiful milk supply. Giving birth vaginally makes this process much easier. For example, when babies are with their mothers uninterrupted for the first hour after birth, after 20 minutes or so, most infants will begin rooting motions and, if given the opportunity, will make crawling movements toward the breast in an effort to latch on. Likewise, babies who "room in" with their mothers from birth, and who nurse at will, gain more weight and nurse well sooner, on average. Off to a good start, these are the same babies who probably will nurse for more months overall.

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Mandy-Saint Louis Doula