Thursday, December 23, 2010


I've had the opportunity to attend several very interesting and eye-opening births during the course of the past year. A few were with moms who had c-sections previously. Two, in particular, stand out in my memory because they happened within a few days of each other but had very different patterns. One mother had a successful VBAC and the other had an emergency repeat section. Both moms and their babies are doing well. I hadn't attended a VBAC or even a TOLAC in a while so it was interesting to see how things can go and how I applied my midwifery skills in each situation. Granted, I was their doula and not their midwife, I couldn't help but to apply my midwifery training to give these women the best care I know how to give. And I'm glad I did.

When the mom who experienced the repeat c-section complained that she "felt a pop or pulling sensation" in her lower abdomen I knew to watch her baby's heart rate and her contraction pattern closely. Sure enough, within 20 min, her contractions became in-coordinate and her baby's heart rate began taking disturbing dips. Her midwife and I agreed that this wasn't going in a positive direction and the attending OB was called in to perform the c-section. After being rushed into surgery, it was discovered that this mom's uterus had indeed begun to rupture and her baby was in certain distress. He was fine, thankfully.

A few weeks later, the other VBAC mom went into labor spontaneously on a clear, cold morning and I met her at her house to monitor her progress. after a while, she began to feel some slight rectal pressure and we decided that it was time to move to the hospital where her midwife was awaiting us. This mother went on to birth her baby serenely and without incident. I felt confident at this birth because I knew what to look for. I knew what a uterine rupture could potentially look like and how it should be handled. Seeing that rupture in the previous birth, made me more aware of the fact that a rupture is certainly possible for every laboring woman regardless of their birth history. It also made me aware of the realities of a rupture. Its not exploding uteri or sudden death. It's often silent and relatively painless. Therefore, VBAC requires more vigilance, care, and respect.

The issue of VBAC, when discussed among professionals and lay-people alike, is often polarized. Many people, mostly health professionals, feel that attempting to give birth vaginally after having a surgical birth is inherently dangerous and they often spread that sentiment to the patients they come into contact with. There is also a contingent of people who feel that VBAC holds no increased risk at all. And then, there are folks like myself who feel that VBAC does potentially hold increased risk, especially if mom's medical/birth history is not a great one.

I think it's important to promote VBAC as a viable choice for moms who would like to attempt it. I also think it's important for everyone involved to be on the same page. That means midwife, mother, partner, back-up or co-managing OB, etc. Until that and malpractice reform happens, the issue of VBAC will remain polarized and access will be limited. And that isn't the healthiest scenario for moms and babies.

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