What to Expect about VBAC? Not Much.
So we all know that What to Expect When You’re Expecting is the preeminent source on pregnancy and childbirth for women in the United States, right?
I mean, copies of that books are everywhere right? So it must be “the best,” right?
Well, that’s what some clever (and aggressive) marketing would have us think. But it’s not necessarily true.
(And for the record, WTEWYE is not the “best” book on pregnancy and childbirth, in my honest opinion.)
But I am here to offer a “critique” of the “What to Expect” website’s advice-ish page on VBAC. (Yes, I’m blogging about the silly things people say about VBAC uh-gain.)
Because if women are reading the “What to Expect” site when they’re trying to make a decision between VBAC and repeat cesarean, then they are gaining some seriously misleading and unhelpful information about VBAC.
Just take a look at some of the statements I found on the site:
“Forty percent of women who had a prior cesarean section do end up having a repeat.”
This is a misleading statement, though perhaps unintentionally. Of all women with prior cesareans in the United States, less than 10% currently even attempt a VBAC. So this means that over 90% of women will “end up having a repeat.”
But even if the author of this page meant to convey the rates of VBACs that are successful or unsuccessful (or that end in a vaginal birth or a cesarean section), this statement is still misleading. With VBAC success rates ranging between 6o% and 80%, it seems more accurate to state that “twenty to forty percent of women who had a prior cesarean section and who attempt a VBAC do end up having a repeat.”
Even better? How about, “Sixty to eighty percent of women who try for a VBAC do end up having a vaginal birth.” (See how much more accurate and positive that statement is?)
“Causes like fetal distress, preeclampsia, a breech position, or placenta previa don’t generally spill over from pregnancy to pregnancy, nor is having had a large baby before any reason to think you’ll have one this time (especially if you kept your paws off the Krispy Kremes and kept your weight gain under control). If the reason was a chronic condition like high blood pressure or diabetes, though, you’d better steel yourself for another surgery.”
Why don’t we throw in a few fat-slurs in there and call it a day!
I mean, I appreciate some good “girlfriend advice” as much as the next gal,* but this seems more like advice from some passive-aggressive chick who likes to put down her overweight pals with snarky comments about doughnuts.
Why not offer some information about prenatal nutrition and its role in helping women to achieve healthy pregnancies and healthy births? (And for what it’s worth, being classified as “overweight” or “obese” does not necessarily mean that a woman isn’t eating a good prenatal diet!!!)
And why not point women who might need to “steel themselves up for another surgery” toward some cesarean support groups such as ICAN?
Otherwise, the advice here just seems insensitive, and even a bit mean. (Or perhaps I’m the overly insensitive type? Perhaps. I do love me some Krispy Kremes after all!)
“Remember that there’s no advantage (moral or otherwise) to a VBAC, so even if you could try for one, you’re absolutely entitled not to go for it if the risks make you uneasy.”
Okay. You know those cartoons where the character’s face turns red and then steam starts shooting out of their ears and there are all sorts of steam engine or train whistle sound effects?
That’s exactly what was going on inside my head when I read this sentence.
A moral advantage to VBAC? You mean the sort of advantage where St. Peter is gonna be all like, “Well, lady, you’d be getting through these here gates to heaven if you had just chosen that VBAC over your repeat cesarean. TOO BAD YOU DIDN’T TAKE THE MORAL PATH!!!”
No! There isn’t a moral advantage to VBAC! And there’s no moral advantage to repeat cesarean either! (Although there are moral advantages to making sure that women are accurately and thoroughly informed about the risks and benefits of both of these birthing options!)
Look, I agree with the end of this statement: any woman with a scarred uterus is absolutely entitled not to go for a VBAC if the risk (of uterine rupture) makes her uneasy.
But, as should be obvious, any woman with a scarred uterus is absolutely entitled not to go for a repeat cesarean if the risks make her uneasy.
Oh, and there are some “otherwise” advantages to VBAC. In fact, there are advantages for women (e.g. a lower maternal mortality rate when compared with elective repeat cesarean) and for their babies (e.g. a significantly lower rates of respiratory morbidity and NICU admission when compared with babies born via elective repeat cesarean)!
So don’t go telling women that there are no advantages! Exclamation point!
“…they might want to keep you off the meds to avoid masking the pain that could point to potential rupture.”
Well, sure, they might. I’ve heard of some individual practitioners having a “no epidural during VBAC” policy in place.
But it should also be noted that even ACOG notes that epidurals “rarely mask the signs and symptoms of uterine rupture.” So while there may be good reasons to approach epidurals with some level of caution in any labor, there are also good reasons for women to question those “no epidurals during VBAC” policies.
“Finally, if it doesn’t work out (and remember one in five births are cesarean), try to take it in stride.”
No, remember this: One in three births are cesarean.
“The happy ending — healthy you, healthy baby — is really all that matters.”
BLAAAARRRRRRGHHHH! STEAM COMING OUT OF THE EARS AGAIN!!!!
I wrote about statements such as this one a long time ago. In brief?
Healthy moms and healthy babies do matter. They matter a whole hell of a lot. But they’re not all that matters.
So in the end? While I’m sure that the authors of WTEWYE are really, truly well-meaning individuals who just want to help out a pregnant women or two (million), I think my expectations of their advice have been tremendously lowered after reading their “lowdown on VBACs.”
* Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience is much better at the “girlfriend advice” on pregnancy and childbirth, in my opinion.