A VBAC Odyssey

by Jill A. Kuhn
Web Exclusive

My birth saga starts at around 34 weeks of pregnancy when the midwife I had been seeing informed me that because of her own liability she had to refer me to an OB and could no longer see me. This was because I had a C-section with my 1st daughter and was now unnecessarily marked as “high risk.” She referred me to a physician who was supposed to be “VBAC friendly” but I quickly found out this was not the case. Thus, my whirlwind education into the hostile world of VBACs began. I called numerous hospitals and OBs and not one of them would allow me to deliver as a VBAC. I quickly learned that only 14.5% of women had VBACs in the whole state of California even though 80%-90% of women can be successful at it if given the opportunity. Liability was only a small part of the reason that OB’s did not want to do VBAC’s. Rather, they often put their own needs and wants above their patient. I entered a world of smoke screens, fabrications and lack of respect for the Hippocratic oath. I was stunned to realize that the right of women to choose the birth that is safest for themselves and their babies was severely limited.

I discovered, after reviewing numerous medical journals, ACOG statements and policy, and midwifery journals that the feared liability of a “uterine rupture” was highly exaggerated. In fact, a baby is more likely to die as the result of an amniocentesis than for a C-section scar to rupture. Ironically, I was encouraged to have an amnio (which I declined), but was completely disallowed from having a VBAC. I was not told that there is a greater likelihood of something going wrong for ANY woman in labor than for a C-section scar to rupture. When a uterine scar does “rupture,” (less than 1% of the time) it is rarely fatal to the mother or the baby. In fact, with most ruptures or “dehiscences” baby and mom are just fine. Conversely, elective C-section has a higher risk of maternal and fetal death, of anesthesia complications, of injury to other organs, of infection, and of respiratory distress in the infant when compared to VBAC. Even in the best of circumstances the recovery from a C-section is arduous and fraught with pain and difficulty caring for a baby and other children. After all, it is major abdominal surgery! Unfortunately, women are rarely fully informed of the risks of C-section. As a result, too many women have initial C-sections and are then forced to consent to elective C-section in subsequent births, because they cannot find someone who will “allow” them to have a vaginal birth.

I saw the obstetrician to whom I had been referred at 35 weeks. She insisted that she would not allow me to labor, before even examining me or reviewing my chart. She wanted me to schedule a C-section for the 38th week of my pregnancy to fit neatly into her 9-5 schedule. She also told me, “I don’t do VBAC’s, because I don’t want to spend all day in court.” As there had been some question whether my baby was breech, my husband, Steve, and I decided not to burn any bridges with this physician…just yet. We politely left her office with another appointment in two weeks. We never returned. I was stunned! At 35 weeks of pregnancy I did not have a healthcare provider to deliver my baby.

By the next day my shock had turned into anger. I decided that I needed to get moving if I was to find someone who would see me prenatally and deliver my baby vaginally. I searched the Internet for hours trying to find a VBAC friendly birth center in California. I wanted a midwife to deliver my baby, since midwives are trained to see birth as normal and healthy in the vast majority of cases. Conversely, many obstetricians see birth as abnormal and thus see every normal turn of labor as a potential problem. Furthermore, obstetricians are surgeons. So, surgery is often the solution to conjured up dilemmas. Twenty-six percent of pregnant women are sectioned in the United States, with some hospitals cutting as many as half of their pregnant patients. Yet, our infant and maternal morbidity rates are no better than countries that have much lower section rates. Physicians are quick to intervene with machinery or surgery for fear that something may go wrong and unwittingly create a self-fulfilling prophecy. I did not want to labor or give birth in this environment.

I e-mailed several midwives and the next day called several more. I also posted messages on the website for Mothering magazine and joined the International Cesarean Awareness Network (ICAN) listserv asking for help. Some of the birth centers I contacted would not accept me because I was a VBAC or because it was too late in my pregnancy. Then an angel replied to my post on the Mothering boards and gave me the name of Marcia McCulley, a nurse practitioner and licensed nurse midwife, in Simi Valley, CA, 130 miles from our home. She indicated that Marcia “loves doing VBACs.” Marcia sounded too good to be true. Early that evening I called her and she answered her cell phone. We chatted for about 20 minutes. She was trying to get her 3 boys into the car so they could meet their dad at a restaurant for dinner. Even when I asked her if I had called at a bad time she seemed eager to talk to me and completely unruffled with herding them out the door. When my husband came home that night I told him, “I found someone to deliver our baby!” I was ecstatic! I had a really good feeling about her. The next day, I called to schedule an introductory appointment. For the next few days before we met, I was afraid that Marcia would disappear, would reject me as a patient, or was just too good to be true. I continued to be afraid that my scar marked me as a patient that no one would touch.