RAISING ELLE
Fighting (and Beating) Corporate-Speak on VBACs
by Martinique Davis
Jul 23, 2010 | 1216 views | 0 0 comments | 20 20 recommendations | email to a friend | print
I was only one centimeter dilated.

The news was pretty discouraging, especially since my labor had started nearly 12 hours before and Craig and I were now in Grand Junction with nothing to do but wait for a baby. Heeding the advice of the midwife, we left the hospital. I was determined not to come back, either, until I was sure that this baby’s arrival was imminent. I knew my chances of having another cesarean, instead of the VBAC (vaginal birth after cesarean) that I so desperately wanted, would increase exponentially the longer I spent laboring in the hospital.

VBACs are uncommon: The rate of VBAC is currently less than 8 percent in the US. Even if you have had a healthy pregnancy and are the perfect candidate for VBAC, you must find a hospital that allows them and your insurance company must agree to pay for it. These two factors alone make a repeat c-section the only option available to most women.

There is also a more intangible barrier that many women face when deciding to have a VBAC. That is the fear that by trying for one, they will be admonished for recklessly endangering themselves and their babies. This attitude stems, I believe, from the “once a c-section, always a c-section” days. New c-section techniques and better research have shown that while a VBAC carries inherent risks, the incidence of complication is very low: A 2004 study of nearly 18,000 women who attempted VBAC showed that uterine rupture occurred in less than 1 percent of cases, which is nearly the same for those who elect to have a repeat cesarean. The maternal mortality rate is 2.8 per 10,000 for women undergoing trials of labor (or VBAC), and 2.4 per 10,000 for women having an elective cesarean.

Meanwhile, a trial of VBAC is successful more than 75 percent of the time. I was lucky. I was the perfect candidate, who had chosen a hospital (St. Mary’s in Grand Junction) that allowed VBACs; a caregiver (midwife extraordinaire Janet Grant) who informed me of my options and supported my decision; and an insurance company (Rocky Mountain HMO) that would cover it.

But even though I was going to be given the opportunity, that didn’t necessarily mean I was going to get my VBAC. Statistically speaking, the more time you spend in the hospital, the more likely it is that you’ll wind up with an unnecessary intervention like an epidural, which given too early in labor can increase your chances of needing a cesarean. So, in my plight to avoid another c-section, I spent the rest of the day and all of that night exploring the labyrinths of labor. After my water broke, at about 1 a.m. in the hotel room, the contractions rocketed upward immediately in intensity.

“We should go. We should really go.” Craig had been nervous for a full day, patiently awaiting the arrival of this kid, and he was ready to be somewhere besides a hotel room with a laboring wife. A hospital room, preferably, with an army of people who knew what to do with a woman in labor.

“OK,” I grunted, steeling myself to put my shoes on and crawl out of there.

Yet as soon as I had uttered the word, it happened. While I lumbered around the room, collecting my belongings and attempting to make myself look presentable to whomever might be in the hotel lobby in the middle of the night, my contractions stalled. Again. Just as they had when Craig and I started preparing to leave our house the day before, and just as they had when we arrived at the hospital the first time.

“OK, the car’s ready.” Craig had just returned from pulling the car around.

“I’m not ready.”

“What?”

“I’m not going. Not now.”

“Are you kidding?” Craig was incredulous. “Your water just broke. We need to go. To the hospital. Now.”

How could I explain to him what was going on? I barely understood it myself, except that in the last 24 hours I had learned something important about myself in labor: When I was relaxed and comfortable, my labor went as it was supposed to – my contractions got stronger and closer together, working harder to bring this baby into my arms. Any mention of the hospital, though, and it seemed my birthing engines quit working. The traditional medical establishment would likely maintain that this is impossible. Labor doesn’t just start up or slow down at the mention of a single word. But as I sat on the edge of the hotel bed in my 24th hour of labor, next to a bewildered, wild-eyed, sleep-deprived husband, I didn’t much care what the traditional medical establishment would have said.

When I got down to it, I was afraid of going to the hospital.

It was the first time I had admitted it to myself. I was afraid. My first birth experience had been distressing; not in the traumatic, critical way that some births are, but in more subtle ways that had nevertheless deeply affected my sentiments about childbirth. I had been in France, stumbling through a just-learned language and an unknown medical system, feeling desperately alone. Due to circumstances seemingly beyond my control, I wound up in a hospital I had never been to before, speaking in French to a doctor I had never met, preparing for a scheduled c-section that I didn’t want (and didn’t need, for that matter: Elle wound up not being breech, after all.) C-sections save lives. This I knew. But there are also risks – related to this surgery, as with any surgery – that I was afraid of. Ten years prior, I had quit breathing during a routine surgery; I was told I shouldn’t go under anesthesia again, unless it was absolutely vital.

Elle’s cesarean birth went without complication (medically, at least.) Nevertheless, the sight of a slate-grey operating table glistening in bright artificial lights still gives me a severe case of the heebie-jeebies.

My fear of going to the hospital, which I had been trying to swallow since labor had started more than a day ago, was intimately linked to my fear of going under the knife. This was even after a successful, no-complications c-section with Elle.

I couldn’t explain this fear to Craig; I was just realizing it myself.

“Trust me. We’re not going to have this baby in this hotel room,” I finally convinced him, and lumbered back into the bathroom to take another bath.

It wasn’t until four hours later that I could face the long, stark hallways and sterile scent of the hospital, and another five hours after that that Emme finally arrived.

In those hours, what had started simply as the physical sensations related to the process of giving birth merged with a spiritual stirring, inextricably connected to confronting a significant challenge; a challenge that both tested my physical limits, but also danced around the boundaries of my fear and my faith.

To be continued next week.
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