My Very Own VBAC Whopper(s)
Anyone who has read my VBAC story might remember that my VBAC itself occurred after I switched care providers at nearly 37 weeks into my pregnancy.
Obviously, this is not something that one does “on a whim.”
It’s hard to do anything on a whim when you have an eight-pound person tucked inside your midsection!
And so my decision to seek a new care provider in the last four weeks of my pregnancy was not a “whim” decision but was instead a decision informed by my own careful (yet harried) reflection and research.
And it was a decision I made in reponse to the blatant misinformation about VBAC and repeat cesarean that my original OB/GYN had given me in an attempt to “talk me into” an (unnecessary) repeat cesarean.
So in the the spirit of my request for your stories about the lies, misinformation, and/or miscommunication you’ve experienced when it comes to VBAC, I’m going to share my own story of “Very Bad At Communication” here:
It all started when my obstetrician informed me that he “needed” to do an ultrasound at my 36 week appointment so that he could measure my lower uterine segment. As he told me, if my lower uterine segment (LUS) was “too thin,” we would need to schedule a repeat cesarean. If it was not “too thin,” then I could “attempt a trial of labor.”
(For what it’s worth, I’ve found that care providers who use phrases like “attempting a trial of labor” tend not to demonstrate much confidence in vaginal birth after cesarean.)
The warning bells started blaring in my head when he told me that, “You know, just last week, a mom came in here, and we measured her LUS, and it was too thin for a VBAC. She’s gonna have to do a c-section.”
Why did he share that information with me?
I’m guessing it was his own way of telling me not to get my hopes up (because he was going to shatter them no matter what the ultrasound showed?).
And then I had the ultrasound.
The sonographer determined that my LUS was measuring approximately 3.7 mm thick.
And I, I who had done myVBAC research–I who had scoured PubMed for articles on VBAC, including the then-published articles on using LUS measurements to predict uterine rupture–celebrated for a brief moment, because most studies on this topic recommended anywhere from 1.5 mm – 3.5 mm as a “safe cut off point” for attempting a VBAC.
Even if those studies were flawed in some ways, 3.7 mm still made me safe in their eyes!
Except then my OB/GYN told me that my LUS needed to be 5 mm thick in order to safely attempt a vaginal birth.
The devastation started creeping in. Those “warning bells” were trying to tell me something after all. (And they had probably been ringing all throughout my pregnancy, but that’s another issue entirely.)
The sonographer noted the immediate change in my expression and attempted once more to measure my LUS, just to see if there was any one point that was 5 mm thick.
And there wasn’t.
I immediately tried to ask about the other studies I had read, but my OB/GYN interrupted me mid-question and said, “Kristen, I’m sorry, we need to schedule a repeat cesarean.”
I tried again. “Well, what is the risk of uterine rupture with a LUS measuring less than 5 mm?”
His response? “The risk of uterine rupture during all VBACs is 2%.” (By the way, that’s not true. And it didn’t answer my question.)
I tried again. “Hmm, that seems pretty high! And doesn’t pitocin…”
He interrupted me. “The risk of uterine rupture during all VBACs is 2%. Period. And anyway, you never know if you’ll need pitocin!“
(I was trying to ask him about how pitocin affects the risk of uterine rupture. For what it’s worth, pitocin augmentation and induction have been shown to increase the uterine rupture rate from approximately .4% to .9% and 1.1%, respectively.)
I tried again. “Well, what are the risks of repeat cesarean as compared to VBAC? Will having this c-section have any negative effect on my future pregnancies or births?”
His response? “No, repeat c-sections are no big deal! You can have as many of them as you want! And hey! Now you don’t have to worry about incontinence issues in the future!”
(Note: just six months prior, he had informed me about how he only recommends VBACs to women who want more than two children since third, fourth, etc. cesareans can carry so many extra risks and complications.)
I tried again, people! “But didn’t you say…”
And here’s where he threw down the gauntlet.
Well, first he turned to my husband and chuckled, “I’m really making her angry, aren’t I?”
And then he said, “Look, Kristen, we need to schedule your repeat. Period. There’s no more discussion. Now, let’s see, you’re due on May 27th, I’m going to Italy at the beginning of May…how does May 20th look?”
I was stunned. (And pisssssed! Seriously, that patronizing crap he pulled with my husband was totally uncalled for. And it’s what infuriated Tim the most throughout the entire “conversation.”)
But I was also searing with the hormonal rush that is the last few weeks of pregnancy. I was on the absolute precipice of tears. And I held myself together just long enough to mutter, “Well, we’ve got a two-year-old, so we’re gonna have to find a babysitter before we schedule anything.”
And Tim and I left that office so fast that we forgot our jackets in the waiting room.
The rest is history.
With the help of our doula, we found a new care provider.
I went on to have not only a successful VBAC but also my hospital’s first waterbirth.
And I was eternally grateful that I had made the terrifying yet empowering decision to switch to a more supportive care provider at such a late stage in my pregnancy.
(And, to his partial credit, my original OB/GYN even called me at home–and my husband on his personal cell phone–to tell me that he had “gone and done his research” and “discovered” that my LUS measurements were “alright for a trial of labor afterall.”)
But what if I hadn’t done all that research?
What if I had allowed myself to fall prey to my original OB/GYN’s non-evidence-based claims about VBAC and uterine rupture?
Should I have even been expected to have read those relatively obscure studies on LUS measurements anyway?
Thinking about the potential answers to those questions make me realize just how exceedingly important the issue of VBAC-related patient counseling is.