Tuesday, November 13, 2007

The Natural Way

I just finished reading a highly-recommended (although somewhat out-dated) book called Birth After Cesarean that I expected to convey the medical facts about repeat cesarean vs. VBAC risks and benefits. Although the summary of the book was up-front in revealing that the author had reached a strong pro-VBAC conclusion, I was surprised to find just how heavily-laced with bias the book really was. Basically, it compared the risks of infection and surgical complications to the risk of uterine rupture and came to the conclusion that the risk of uterine rupture in VBAC is statistically comparable to the risks associated with cesarean... so it’s not reasonable to consider the risks significant because VBAC is just fundamentally "better."

My thoughts on this book are probably affected by my own emotional bias against VBAC in general after feeling like the unrepresented minority that is run over by this whole debate. I can’t even begin to list the times I have been criticized not only for my decision to have a repeat c-section, but for having the first one – mostly by people who had no idea what they were talking about. Since the extremely high c-section rate is decried in headline after headline, most people understand that VBAC is safe for most mothers and I guess they think they are helping me out by telling me about it.

I didn’t have a choice about my fist cesarean. It didn’t happen because my labor stalled, because my doctors were too impatient to let nature take its course. Yes, I was induced. Yes, I labored on pitocin for the better part of a whole day. Yes, the decision to operate was based on the fact that I was no closer to having a baby at the end of this process than at the beginning. Unlike the scenarios that are always detailed in these pro-VBAC articles and books, I didn’t have a choice – or at least not what I considered a rational choice. I had to have the baby then and there or risk my blood pressure going even farther into the zone of life-threatening to me and my child. There was simply no more time to give. The induction was my doctor’s best effort at giving me a chance to avoid a c-section, not his desire for a more convenient schedule. It didn’t work, so the c-section was the next-best choice we had.

There are plenty of women out there just like me. For us, the benefits of “the birthing experience” and the chance to be “an active participant” in labor are not realistic concerns compared to the reality of knowing that our own bodies just didn’t hold up to the demands of pregnancy and labor for reasons beyond our control. I agree that any surgery should be avoided if possible, and I’m happy for the moms who can weigh these factors and make the decision to go for it. I’m just not one of them.

The bottom line – I am choosing an “elective repeat cesarean” for Baby #2 at the recommendation of a doctor that I trust very much, not at the whim of a broken medical system. I am choosing this because:

1 – 1% risk is too much for me. Other sources say the risk of rupture is 4/1000. Either way, I am the person who will spend an hour making sure the carseat is properly installed before driving 3 blocks in the neighborhood. I am not the person who looks at a 1/250 risk and believes it won’t happen to me. Also, I remember childbirth and I remember how rarely anyone came to check on me, even though I was high-risk. I have no illusions that my VBAC would be “closely monitored” for signs of uterine rupture or any other complication.

2 – I believe, based on what I have studied and what I know about this pregnancy, that a scheduled c-section gives me the best chance of avoiding a repeat of the somewhat traumatic birth and recovery that I experienced last time. I have been fearful my entire pregnancy because of the complications of baby #1. With #1, my blood pressure was so high after delivery that I had to be put on magnesium sulfate, and as a result, I don’t remember the first 24 hours or so after the delivery. There aren’t any statistics that can change how I feel about having no memory of the first time I held my child.

I know that cesarean is not 100% safe. I’m not going into this without an element of fear at undergoing major surgery. I know the recovery is more difficult. I am informed. Sometimes I think I am overly informed, but I can’t shake the feeling that the whole story – the part of it that I fit into - is still not being told.

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