This is a story about a young man named Slate. He was born on 3/22/14 and weighed 6 pounds, 4 ounces. His birth represents another great VBAC story. His Mom came to me rather late in her pregnancy because of a problem that is far too common in obstetrical practice: she sensed that her provider started to fade in her support for VBAC. As her due date was rapidly approaching she felt increasingly alone in her goal to achieve a vaginal delivery. Her provider would, “Allow,” her to, “Try,” for a VBAC, but she was feeling less and less supported. She made a very difficult decision to change providers at the end of pregnancy…
I’m sad to say I hear this story and others like it on an almost daily basis. At the beginning of the pregnancy physicians appear to be, and for the most part I believe they probably believe they are, supportive of VBAC. Yet, as the pregnancy progresses and the reality of VBAC becomes more real, the physician begins to pull away and starts presenting an array of obstacles patients must overcome. Recently, for example, a patient transferred to me at the very end of her pregnancy because her physician told her if she did not go into labor spontaneously by her due date she would have to undergo a repeat c-section because it was unsafe to induce a patient who wanted a VBAC. Aside from being untrue and unsupported by the research evidence, this had never come up in the 37 weeks of office visits prior to that point in the pregnancy. Another patient recently transferred her care to me in the last weeks of her pregnancy because her physician told her that she (the physician) would absolutely, “Allow” her a trial of VBAC if she (the patient) began labor spontaneously Monday through Friday between 8:00 AM and 4:00 PM, but outside of those hours one of her partners would be covering. The physician went on to point out that since she (the patient) had undergone two prior c-sections it was very unlikely any of the covering physicians would, “Allow” a VBAC trial. As a result the physician was suggesting a repeat c-section, “Just to make things simpler.” Of course, none of this had come up until the 37th week of the pregnancy. Both of these patients went on to have successful VBAC’s after entering labor spontaneously.
I think there are a few important take away points here worth mentioning:
- If a physician uses the word, “Allow,” beware. I don’t allow any patient to do anything. You are in charge of your pregnancy and birth, not me and not the hospital. I’m simply a consultant that gives you advice that you may or may not elect to use.
- There is a tremendous difference between “Allowing,” or, “Tolerating,” or merely saying, “Yes,” on a questionnaire when asked about accepting VBAC patients vs. passionately championing VBAC. You want a provider that will partner with you to help you achieve the birth you desire. For providers, VBAC is a great deal of extra work. It has to be something they feel strongly about; something they feel called to do or they will weaken in their support when things get difficult.
- Successful VBAC providers need practice; they need to care for VBAC patients frequently. Talk to a prospective provider about how often they have patients attempt VBAC, and how often their patients are successful at achieving VBAC. Ask a prospective provider why they do VBAC’s and why they think some providers elect not to do VBAC’s.
- With few exceptions, the majority of women who have had a prior cesarean section(s) are candidates for a trial of labor and VBAC.