Our VBAC saga

Our first experience with childbirth did not proceed the way we expected. My wife labored for 23 hours, dilating to 8cm before things stalled. Finally, she was wheeled in for the C-section. Our son's head was in the right position, but too large to get through the pelvic canal. He wasn't going anywhere without help.

We both regretted not being able to have a natural birth. People reminded us, and we reminded each other, that delivering a healthy baby is the most important thing. And it is. But this wise thought doesn't abolish all feelings of disappointment. Plus, there was the long and difficult recovery. My wife still wishes deeply that the surgery could have been avoided.

When she became pregnant again, we were given another opportunity. And yet, 28 days from now, we will be going in for a scheduled C. How has this come about?

A number of things have influenced the decision. One was my wife's prior experience with labor. It's not unlikely that Michael's sibling will have the same trouble getting out as he did. Basically, Y. has at least a 50 per cent chance of needing a repeat C whatever choice she makes. There's a widely-circulated rumor, which our doctors were happy to repeat, that Asian-Western couples have a high rate of C-section due to mismatches between mom's pelvis and baby's genes. In any case, oversized heads can be found on both sides of the family. Why go through another protracted ordeal only to end up, once again, in surgery?

Another factor is the hospital. Doctors have been reportedly started to discourge VBACs out of fear of litigation. Some of the cases cited involve slow response time, lack of staff, or lack of proper attention. Natural birth advocates argue that, under the best conditions, a VBAC should be no less safe than a C. But what is the state of most hospitals, even the better-ranked ones? Chaotic. Bureaucratic. Getting a nurse's attention, let alone the doctor's, is like trying to get through to the phone company.

Staff may not always be competent, mixups happen, patient information can be misinterpreted. Communication problems occur, especially during shift transitions. If a uterine rupture does happen, the window of time could be crucial. But ruptures are sometimes hard to detect. The VBAC seems to call out for closer monitoring and more resources than many hospitals are able to provide.

There are two ways this issue could have been overcome. One would be to get a doula -- a person whose specific job is to be there for you throughout the process. If we were going to do that, however, we should have planned for it earlier in the pregnancy. A month before delivery is a bit late.

Another would have been to choose an outstanding hospital. Y. thinks she'd have the confidence to try the natural birth if we went to the Famous Teaching Hospital in Baltimore. The problem is, it's in Baltimore. I wasn't keen on the idea. What if we get caught in rush hour traffic? My wife's in agony, and we're stuck behind this truck on Pratt... Ugh. I advocated finding a hospital closer to home. But no local hospital meets the standards of the Famous Teaching Hospital in Baltimore. If the choice of hospital governed this decision, then the repeat C is my fault.

There were some other influencing factors. My mother-in-law, who went through a succession of vaginal births in rural China, strongly favoured the C-section. My sis-in-law also favoured it, as her own attempt at a VBAC led to a life-threatening emergency. A friend who did give birth "the way God intended" says she can't laugh without starting to pee.

In short, we might have gone for the natural birth if some or all of the following were true:

-- I hadn't argued against Baltimore.
-- My wife was firmly committed to the VBAC.
-- I was a strong advocate of the VBAC.
-- My wife wasn't so worried about the VBAC.
-- Her first C-section had been due to breech, or something other than "failure to progress"
-- Trusted relatives or friends advocated natural birth.
-- If the available studies clearly showed VBAC is the safer option.

And most importantly:

-- If the first delivery hadn't been a C.

So, there it is (I think).