Erstwhile Dear

I was able to have three vbacs after an unplanned c-section with my first baby. Some of the challenges in pursuing these vbacs were the same for each pregnancy—2nd, 3rd, and 4th.

This is written out of conversations I have had with women wanting to have vaginal births after unexpected c-sections. It’s not for everyone, and the language likely won’t make much sense to you if you have not experienced what I’m describing.

This is a topic for which I feel deep empathy. I hope that my discussion of caregivers does not offend caregivers reading this. Much of what I describe was subtly implied and my focus here is on the fragility of those hoping to be brave.

Here we go.

Pursuing a vbac takes mustering together as much courage as you can and keeping that courage by your side throughout the pregnancy.

Pursuing a vbac asks you to balance the fragility you feel about your c-section and take it in hand with the hope you feel about a future birth.

It takes educating yourself about the risks which caregivers will be concerned about, and having a sense of what they are going to say before they say it.

Pursuing a vbac means making space to be disappointed when a caregiver may ask you at each appointment—“And…are you still planning to try for a vbac?”

Pursuing a vbac means digging back up the trauma you felt in your first birth, and working through it.

In my case it took acknowledging that this hope was the current deepest hope of my heart, but that it was one I was only just grasping with fragile fingers, because I also somehow believed that my ability to give birth had in fact been sliced from me.

It means going into the required meeting for your “consultation” about a “trial of labor” at a hospital knowing that you may have to disagree when/if they say, “Wouldn’t it be safer to have another c-section?”

All of this is totally worth it.

Here are some things that helped me pursue vbacs:

1. If you have mixed feelings about the care you received in your first birth, consider switching to a new hospital. I would not have undertaken this myself, but the doula I hired for my second birth sensed how hurt and resentful I was about certain elements of my care, and encouraged me to switch to a nearby community hospital.

• Reasons for leaving can be both leaving behind a place of emotional trauma, and pursuing a different type of care, it doesn’t have to be one or the other.

2. Ask for the c-section rate at your hospital. You can check it online, and it is good to ask in person as well. Ask the care providers at the hospital how they feel about their rate, and use it as a discussion tool. This is a good idea for discussion for when you go into your required consultation before the “trial of labor.”

3.  Check your personal vbac success rate calculation before you discuss your plan with providers. This will give you a sense of what concerns they may have, like your weight, your previous labor experience, and your age. The facts don’t need to defeat you, but it is good to know them.

4. If you are switching hospitals, visit the previous hospital’s medical records office, and obtain the record of your birth to review with your doula or new caregiver. I went to the medical records office with my little toddler in a stroller, and we sat as the employee printed off a six inch stack of paper and handed it to me. Then I brought that to my new midwife and we talked about it together…

5. Find someone to process your c-section with. This could be a doula. This could be your new midwife. This could be a counselor, or a friend who is a really good listener. Allow yourself to mourn what hurt you about the birth, and then: let it fall away from you. After talking with my midwife, and some of the doulas that I interviewed to hire, I was shocked to find myself felt ready to let my disappointment go and move on.

6. Cleansed of some of the elements of grief and disappointment, now reflect on that birth and think about what you can change for the next time:

• For example, I decided that getting an epidural was not an option for me going into my second birth. I felt that statistically the chances of having another c-section went up dramatically if I got an epidural. So I took that option off the table beforehand, committing to myself that I would not do it. I would sometimes share this commitment and the reasoning behind it with caregivers. They would usually shrug and say something like, “Well, every birth is different.” I felt this was not only statistically misleading, but also it wasn’t helpful to me to hear it, so I did not engage with these comments.
• A decision that followed this decision was that I couldn’t be as overdue with my second baby as I was with my first (two weeks overdue, supposedly).
• So I did two things:
  • First, I educated myself about my cycle and learned that I had a 31 day cycle instead of a 28 day cycle. Caregivers typically calculate your due date based on a 28 day cycle, unless you tell them otherwise. Throughout my pregnancy, I had to remind caregivers that I had a 31 day cycle to be sure they were calculating correctly. Sometimes it was correctly recorded, other times it was not.
  • As I approached my due date, I asked for any natural inductions that they could offer. That meant making an appointment on my due date for sweeping my membranes.

This commitment is also what encouraged me to hire a doula, though it felt expensive (see #8).

7. While it was wonderful to have had such a happy, big 9lb 10 oz first baby, I decided it would be better for me to do what I could to have a slightly smaller baby the second time around. For my second pregnancy I tried to stop eating as soon as I was full (rather than finishing the dish just because it was in front of me) and I always ate protein first, carbs second.

• In case this is a question in your mind, I typically weigh around 100lbs and I typically gained 30lbs for my pregnancies. I gained 50lbs in my first. The birth weights for my children were as follows, the first birth was a c-section: 9lb 10 oz | 7lbs 11 oz | 8lbs 5 oz | 9lbs 1 ounce.

8. It is definitely worth considering hiring a doula. Yes, it is expensive. Yes, it could be seen as “only” self care. Even though your insurance won’t acknowledge the money saved, the fact is you could very likely go from a $50k birth to a $2k one. If you have great insurance, your doula fee may indeed be equal to what your insurance charges you for your birth. Keep in mind there are doula services offered at reduced rate for certain income levels, but you would want to research these options early in your pregnancy as they book up quickly.

But you won’t have many births in this life, and hiring an doula experienced with vbacs will very likely completely change the birth for you and your partner. Doulas like to interview their potential clients and they want you to interview them as well. So take some time to call and email people, have an interview together, and share your hopes upfront in the conversation.

That’s everything I would tell you, if we sat together and you said you wanted to try for a vbac this time. Know what you want to fight for and feel bold about sharing it, xo.