QUESTION: I had a cesarean for my first child. I am pregnant again and would love to give birth vaginally, but I am frightened. I'm very concerned that it might be more difficult for me emotionally if I try for a VBAC and fail, than if I just schedule a cesarean. What is the best decision for me and my family?
ANSWER: By all means, try! It is a woman's right to pursue her dreams and desires and having just the right birth experience is by no means an exception. Ask yourself if your desire to give birth vaginally after a cesarean is based on what you want, rather than a reaction to outside pressures. If it is your true desire, you are likely to have regrets if you deny yourself the opportunity.
You are right to consider a vaginal birth, since cesarean birth is surgery, which carries its own medical risk for both mother and child. A normal, uncomplicated vaginal birth prepares a baby for breathing when born. Travel through the vaginal canal helps clear the baby's airway passage, while birth by cesarean holds the risk of complication when a baby's lungs are not yet ready for breathing. To avoid respiratory distress, a neonatalogist (newborn specialist) is prepared to immediately suction and stimulate the baby's first breath when the womb is opened.
Coming down the vagina, (like a vigorous massage for the baby!) not only helps squeeze mucous out, readying a newborn for its first breath, but also brings blood circulation to the skin, warming your baby to meet the cooler temperatures outside of the womb.
But what about you? Certainly, a normal, vaginal birth does not require the recovery from surgery afterwards, or the medical risks involved in cutting through the womb. After a vaginal birth, you are more mobile and able to hold and care for your baby more readily. Major surgery may require pain medication at a time when you want to be alert and bonding with your newborn.
You are not alone in your fear of disappointment, should you be unable to deliver vaginally. Like anything that you attempt in life, if you do not reach your desired goal, you will have some sadness about it. But does this mean that you should not try? If there is absolutly no medical reason against VBAC in your case, consider giving yourself a realistic chance to deliver your next baby vaginally.
The overwhelming majority of women I work with in my clinical practice, who come to me for help preparing for VBAC, do so. Their "success" is enhanced by their ability to work with whatever labor they have, not with the "outcome" of cesarean or vaginal delivery. We work together to support a woman's courage to give herself a chance!
Within this supportive prenatal counseling model, women give birth, vaginally or by cesarean, with a sense of accomplishment and satisfaction. The following tips will help you on your journey and are critical to my model of birth preparation which promotes women's growth, rather than focusing on "performance".
It is likely that your labor will indeed progress further than before because you were already stretched by a previous pregnancy and may be more responsive to the hormones of labor the second time around. (And your baby can benefit from the stimulation received from labor contractions, even if born by cesarean).
- Consider your past labor. Look at this from the viewpoint of what went right, rather than what went wrong. For example: If you dilated to five centimeters, before your cesarean, you were half-way to full dilation.
- Your body is always learning and building upon past experiences. In the above example, it is likely you will go further the next time. You never know how much further you will go, unless you try!
- Develop a plan for coping with pain. Many women are not realistically prepared to cope with pain, contributing to distress, the first time around. Gather information on childbirth resources in your area, including childbirth classes which address, rather than gloss over, coping techniques.
- Choose your care provider carefully. Consider which obstetrician or midwife can give you the best support in your plan
for a safe VBAC. Some obstetricians are quite supportive to the process, while other are not. Do your research. Do not assume they are all the same.
- Visualize the past birth as if it had been a vaginal birth. Once you have your birthing team in order, turn your attention inward. Allow yourself to imagine what vaginal delivery might have felt like with your first baby. You have nothing to lose. This is just a visualization, for your pleasure alone.
- Visualize the possibility. Make appropriate plans for a good cesarean experience beforehand, then rest assured you have taken care of this in the case that a cesarean is needed. This will free you to visualize what vaginal birth might entail. You must prepare for it, in order to be ready for it.
- Schedule a postpartum visit. Use this visit to review and integrate your childbirth experience. Identify your strengths in coping with your labor. Discuss your experience with your doula, if she is comfortable doing so, or with a childbirth counselor. Doing so will allow you to process the positive and negative aspects of this very powerful event. Discuss disappointments and celebrate the ways you coped with the power that is nature.
Childbirth is an opportunity for learning more about ourselves and developing our capacity for meeting life's challenges. Give yourself the special attention you deserve, to help you grow stronger in support of your dreams. This is not just an attitude about birth, but about life!
Childbirth is a life process, not a performance. Work through your fears, rather than allow them to hold you back from pursuing your desires, in this or any other endeavor. Refer to my book, An Easier Childbirth for suggestions on journaling and visualization exercises to help you imagine the possibility of a vaginal delivery. Then join us on the pregnancy and childbirth message board for support on your journey.
Copyright 1996-2002. Gayle Peterson. All rights reserved. Used with permission
Gayle Peterson, MSSW, LCSW, PhD is a family therapist specializing in prenatal and family development. She practices in Berkeley, California and is the author of An Easier Childbirth, and Making Healthy Families as well as the audiotape Body Centered Hypnosis for Pregnancy, Bonding and Childbirth. She also writes a family column on the world wide web for ParentsPlace.com and igrandparents.com, and hosts a new, live radio show, "Ask Dr. Gayle" on ivillage internet radio, answering questions on family relationships and parenting, every Friday at 10:00 AM. Information on her work can be viewed at: www.askdrgayle.com. Gayle is a wife, mother of two adult children and a proud grandmother.