The New York Times is reporting that Caesarian births, the most common operations in American hospitals, have reached an all time high in this country. A major reason for the increase is that many doctors and hospitals are now discouraging or even refusing to perform VBACs (vaginal births after c-section.)
About 1.4 million Caesareans were performed in 2007, the latest year for which figures are available. The increases- documented in a report published Tuesday- have caused debate and concern for years. When needed, a Caesarean can save the mother and her child from injury or death, but most experts doubt that one in three women need surgery to give birth. Critics say the operation is being performed too often, needlessly exposing women and babies to the risks of major surgery. The ideal rate is not known, but the World Health Organization and health agencies in the United States have suggested 15 percent…
Repeat Caesareans are another part of the problem. They account for about 40 percent of the total and have become increasingly common in the past 15 years as more and more hospitals have refused to allow women who have had a Caesarean to try to give birth normally. Fewer than 10 percent of women who had Caesareans now have vaginal births, compared with 28.3 percent in 1996. Many hospitals banned vaginal birth after Caesarean because of stringent guidelines set by the obstetricians’ college, which said surgery and anesthesia teams should be “immediately available” whenever a woman with a prior Caesarean was in labor.
The disappearing VBAC is a disturbing trend. I had two of them. When I tell people this, they’re surprised. More and more, I fall into an ever-shrinking minority.
I was not a typical VBAC candidate. I usually follow doctors’ recommendations. I’m not a risk taker with my health or my kids health. I’m not a natural birth advocate either; I love my epidural. I opted for VBACs only because having a c-section was so awful.
Before I had my first baby, I didn’t even understand why having a vaginal birth was preferable to a c-section. Frankly, both exits sounded bad.
At my birthing class, there was a lot of talk from the teacher about how to avoid a c-section, but not to be disappointed or feel like failure of it didn’t happen. I didn’t get what the fuss was about. Why would I feel like a failure? I thought the empathic concern was a San Francisco hippie thing. I felt like– who cares how she’s born, as long as she is OK?
So my big mistake with my first baby was that when my water broke, I didn’t know it. Apparently, water breaking is not usually a sudden dramatic splash like it is in the movies (in fact, nothing about giving birth for me was fast or dramatic like in the movies.) Generally, the doctor breaks the bag of waters when you’re in the hospital, after you’ve been in labor for a while. But if your water does break, you need to go to the hospital immediately because your baby loses that boundary of protection against infection.
About 30 hours into labor, my baby was stuck. My temperature was rising which indicated the baby or I might have an infection. When my doctor recommended the c-section, I took her advice– lying there, exhausted and drugged, I wasn’t in the mood to argue, and like I said, I don’t tend to argue with doctors anyway. When my doctor sat down on my bed and told me very seriously that she thought I needed the operation and I felt like– fine, whatever, just get this baby out!
The problem was the recovery. It was horrible. I was in intense pain for weeks and slight pain where the scar was for months afterward. Somehow, I didn’t fully understand that recovering from major abdominal surgery would be really slow and painful. I couldn’t be there for my baby at the level I wanted to be. She was colicky, and the only way to calm her in those early weeks was to bounce her for hours in your lap while sitting on one of those of giant exercise balls, but because of the incision, I couldn’t bounce. There was a lot I couldn’t do, or couldn’t do easily, and that lasted a long time.
Tests of the placenta came back weeks later to show neither my baby or I had had an infection. Obviously, no one knew we were OK at the time. I probably would have done the same exact thing, except hopefully, been more aware of water breaking and also delaying my epidural because the anesthesia supposedly slows down labor, though no doctor would confirm that for me. The cost of the c-section and 4 day hospital stay it requires, covered by my insurance, was $50,000. The point being hospitals make more money and avoid more lawsuits when they preform c-sections.
After one c-section, at my practice/ hospital, you’re allowed to schedule another for the second pregnancy, but I chose to try a VBAC because the recovery from the operation had been so hard. I waited much longer for the epidural. It was a long labor, but an easy birth. I pushed for just twenty minutes. Within hours, I was sitting “criss cross applesauce” as my daughter would say now. I felt happy and energized. The next day while my baby was having some standard tests, my husband and I walked a couple blocks to get a Jamba Juice. My nurse was pissed when we returned; I wasn’t allowed to leave the hospital, but it didn’t occur to me to ask permission because I felt so good.
The early infanthood with my second baby was a completely different experience than with my first. Right away, I was taking her out on walks. I felt calmer, happier. Part of that may just have been the second baby is less of a shock, you’ve been through it. But also, of course, I just felt so much better. I understood in a way I hadn’t before something basic: women’s bodies are designed to expand and contract with the pregnancy and birth. Even if the whole process seems alarming to someone who’s never had a baby, as it certainly did to me, we heal pretty easily and quickly. On the other hand, getting your abdomen cut open and stitched back up, is a serious physical invasion and feels just like that.
The cost of the VBAC was about $15,000, covered by my insurance.
My third baby, because she was the third, was supposed to “pop out.” She also got stuck. After about fifteen hours of labor, my doctor was ready to do another c-section. Even though I had delayed the epidural again, part of the reason my labor had slowed was that the hospital was no longer allowed to give me the level of Petocin, a drug that speeds up contractions, that I had with my second baby. As the New York Times reports, many hospital policies have changed for VBACs, now only allowing the lowest levels of Petocin. My doctor wanted to give me more, believing it was safe, but the nurse refused, saying it was against hospital policy. Having my doctor and nurse argue while I was in labor made me anxious, as if I weren’t anxious enough already. So I was headed for surgery when my doctor’s shift was up. The new doctor came into the room, examined me, and said, “I think we’re ready to push this baby out. What do you think?”
I told her I thought I was going to have a c-section unless they could up my Petocin.
She said: “No, we’re going to push!”
We are going to push– ha! But like I said, I follow doctors orders so I said OK. I was thinking: this doctor is clearly insane. As she, my husband, and the nurse were all leaning over me, telling me to push I was thinking– where did all these crazy, bossy people come from? But an hour later, I had my 10 lb baby. Yes, surprise! No one had any idea I was going to have a giant baby, but there she was. Recovery was more painful than baby #2 but again, my body felt normal pretty quickly, nothing like the c-section experience.
It’s pretty amazing that how I gave birth was so dependent on the particular doctor whose shift I was on, the nurse, and the hospital policy. I think this happens to a lot of women; how they give birth is influenced by what state or country they live in or random timing like a doctor’s schedule. I’m surprised and disheartened by the massive movement of hospitals away from VBACs. More women, not less, should be attempting them; doctors should stop forcing women into something “safer.”