There was a screening of "The Business of Being Born" in the Dallas/Ft. Worth area in February, followed by a panel taking questions. The vast majority of questions and dialogue were addressing VBACs, or Vaginal Birth After Cesareans. Why so many questions? Like I've said before, in this area of the state, the c-section rate is 50%. No matter where you live, it's probably hovering around 30% -- some more, some a little less. We all know women who have had a c-section. This affects us all, even if you have never had one. Let me explain.
There are so many reasons for the high c-section rate. I am not aiming to explain those in this post, although I will touch on a few.
The phrase that gets me is: "I had to have a c-section because..." If women were not induced or did not have pain medications, they would most likely not have a c-section. Only about 3% of women TRULY need a c-section because of a true medical condition, such as placenta previa, cord prolapse, etc. The World Health Organization has recommended that the c-section rate not be above 10-15%.
And yet, every now and then, a student of mine will map out their labor that ended in a c-section, and I am stumped. I don't know what could have been done differently. More often than not, however, I can tell exactly where labor took a turn that headed down that path -- often introducing pitocin or pain medications.
I had a woman in class a couple of years ago who was attempting a VBAC. She was tiny. Less than 100 pounds and less than 5 feet tall. The first c-section was unavoidable -- cord prolapse -- but she was determined to have a vaginal birth the second time around. She hired a doula and labored beautifully for many hours. She loved labor, in fact. She was so prepared for the birth, physically and mentally. She never dilated past 9 cm. and the baby was not descending. They tried all sorts of positions and movements. She never had any interventions at all. After several hours at a 9, she said she would do it for one more hour. If there were no changes, she would have another c-section. The hour passed, there were no changes, and she had a c-section. She had no regrets though. She gave it her all, loved labor (which was so beneficial for both baby and mom), and ultimately, despite the 2nd c-section, is an advocate for natural labor and birth. She was a wonderful example of taking an active role in her health care and doing her part.
Lately, the biggest reason I am seeing for c-sections is, simply, the time clock. You've been in the hospital too long. They are not going to let you hang out to labor for more than a day. Even a day is extremely generous. Usually, we are talking more like 12 hours. You are taking up space. They can "section" you, make twice as much money, and move you out, on to the next one. Will they tell you that is why you are having a c-section? Of course not. They will call it other things: failure to progress (in their time frame), CPD, or cephalopelvic disproportion, meaning the baby's head is bigger than the pelvic outlet (extremely rare, but very common reason for a c-section), or fetal distress. If any of these things are true emergencies, they will put you under with general anesthesia and do a c-section in a matter of minutes, or less. If they take their time, it's not an emergency. Fetal distress is rarely a diagnosis is natural labors. It usually begins to show up after the introduction of interventions, such as pitocin or pain medications, even continuous monitoring that prohibits mom from moving around.
Plus, if they can get you on the c-section path, as opposed to birthing vaginally, now you will likely (thanks to ACOG, again!) be having all of your babies by c-section. Of course, you can have a vaginal birth after a c-section, but it's very hard to find someone to do them, at least in the DFW area. Subsequent pregnancies become more and more dangerous to babies, as well as moms, who continue having c-sections. It's not just about the birth, but the actual pregnancy. The more c-sections you have, the more likely your baby is to have problems. It is not a good idea. Please, seek out birth attendants who do VBACs.
There are many reasons given for c-sections -- some are legitimate and some are not. I believe that if a woman will educate herself, stay healthy and low risk, trust in her body to start labor on its own, and not have medication to numb her labor and birth, it is highly unlikely that she will have a c-section. If she has done these things and then has a c-section, she can at least know that she did her part to try to not have one, like the woman in the story above. It all comes back to taking responsibility for ourselves and our health care. And ultimately, our babies.
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