C-section vs. VBAC?

The evening on the day Bee was born.

I’ve noticed something about labor, especially for first-time moms: it’s a guarantee that something unexpected will happen. One friend discovered she had a surprise breech baby, another found her hospital too full to admit her, a third had a surprisingly short and uncomplicated labor. For me, I was harboring a secret hope that I’d have an advantage because I was fit. No dice. My labor was 31 hours long and I pushed for two hours before my doctor calmly told me I could keep going as long as I wanted, but he needed to let me know that the baby hadn’t moved a millimeter. I thought about that for a few moments, and then asked about starting a c-section.

In preparing for childbirth a c-section is often presented as a disappointment, a failure, as the worst thing that can happen.  But when I was in the moment it felt different. Though I was wracked by pain I had a moment of clarity where I realized that continuing to push might be what my woman ego wanted, but what was best for my baby was getting her out. There are moments during your pregnancy (and then during the baby’s life) where you become a mother, and where your sense of your motherhood deepens to a new level. This was one of them.

Before giving birth I’d said that my hopes for childbirth were that I would get to experience contractions and pushing — two things that I’d always wondered about since I was a kid, and that not all women who give birth get to do. I also made the same deal with myself that I make when I run marathons: I wanted to greet my baby (and cross that finish line) with no regrets and no disappointments, and no beating myself up over my performance. While wildly different, both are amazing accomplishments that deserve their fully, untarnished glory. (I’ve heard of a husband who told his wife that there was no way childbirth could ever be harder than a marathon. Which made me wonder, what the hell does this guy do to himself during a marathon?!)

So I’ve been contemplating what I’d do next time — c-section vs. VBAC — since the recovery room. Within the hour after Beatrice was born I said to Adam, “That wasn’t so bad. I could do that again.” He now kicks himself for not making me sign on the dotted line then and there. Because as a husband it was no contest — watching me labor for hours vs. a quick surgery? It also helped because my recovery was really easy. I was off prescription painkillers by the time I left the hospital, and by the end of the first week I was able to take a two-mile walk.

I thought I wouldn’t have a choice on the matter since I’d heard a lot of docs require you to wait at least two years after a c-section before attempting a VBAC (or opting for a TOLAC — a trial of labor after Cesarean, my doctor’s preferred term). But my doc said it was fine. We went over the risks and they seemed pretty equal to me.

My biggest concern was not ending up with a long, hard labor again and THEN a c-section. If I can avoid it, I don’t want to start off my next baby that sleep deprived and exhausted again. So I asked my doc could I do a TOLAC and if it wasn’t going well, say “I’m done, let’s do the c-section” at any point? And to my great surprise she said yes!

So that was my plan until my latest visit, where she mentioned there was a new TOLAC success predictor model. She entered all sorts of info on me, from my height and weight to what happened during childbirth last time, and the program gave me score of my chances of success.

It wasn’t good.

Apparently docs used to think that if you got all the way to pushing and it didn’t work you’d have a good chance of success, because your body dilated and progressed and all of that good stuff. But now they think you don’t have a great chance because if pushing didn’t work last time, it’s more likely that can happen again, and there isn’t much they can do to help that along. My doc also pointed out that prolonged pushing without progress is really hard on your uterine scar.

When asked, my doctor assured me that if I opted to do a c-section I didn’t have to schedule it in advance (although they won’t let me go late), which is important to me, because I’d much prefer to go into labor and then go right to the c-section. So as of now that’s my game plan. If my labor miraculously progresses really fast in the couple of hours I’m in labor before I’m able to get settled in the hospital, well, we can reevaluate that then (there is the phenomenon of the “surprise VBAC”). But otherwise, c-section it is. And that feels like a good choice – the best thing for both the baby and me.

And as things usually go differently than you expect, we’ll see how well that plan works!

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