A (Ridiculously) Easy Communication Shift
I support VBAC (vaginal birth after cesarean).
This is different from saying that I think that every woman who has had a cesarean should go on to have a VBAC.
It is different from saying that I don’t support repeat cesarean, or the choice to have a repeat cesarean.
It is even different from saying that I consider VBAC and its associated risks to be “no big deal.”
I don’t think that every VBAC candidate should plan a VBAC (it’s her choice, not mine), and I do support the right to choose repeat cesarean (VBAC is not for every woman), and I do consider the increased risk of uterine rupture during VBAC to be a big deal (it’s a small risk, but one that is still vastly increased from the risk for a woman without a scar on her uterus–all the more reason to work to cut the primary cesarean rate!).
But–BUT–when a care provider misleads a woman about the option between VBAC and repeat cesarean, I get pretty incensed. (I’ve even dedicated a whole blog series to it.)
I get especially angry when a woman expresses an interest in VBAC and then her care provider immediately shuts her down, thereby muddling her ability to make an informed decision.
Maternity care–and truly, any medical care–should look more like a partnership than a dictatorship.
But too often, the conversation looks like this:
Why would you want to have a VBAC? [Insert comment about how unsafe/ridiculous/selfish VBACs are.] Let’s schedule your c-section.
Why would you want to have a VBAC? [Insert horror story.] Let’s schedule your c-section.
No, you can’t have a VBAC after more than one cesarean. Let’s schedule your c-section.
Instead, it should look like this:
I don’t attend VBACs. [Insert explanation about cost of malpractice insurance/hospital policy/bad experience.] But both ACOG and the National Institutes of Health consider VBAC to be a reasonable option for most women with prior cesareans, especially if they have a low-transverse incision. If a VBAC is what you want, then I can refer you to another care provider in the area who does attend them.
I don’t attend VBACs after multiple cesareans. But ACOG does say that two prior cesareans should not automatically preclude a woman from planning a VBAC. I can refer you to a local care provider who does attend VBACs after two cesareans if that is what you’d like.
And I, for one, think that shifting these conversations should be easy. They should be ridiculously easy.
Left as they are, they are just plain ridiculous.
If you expressed an interest in VBAC, what was your care provider’s immediate response? If s/he didn’t attend VBACs, did s/he refer you to another care provider?
Or did you express a desire in repeat cesarean only to find your preference met with derision (which is, to be clear, different from inquisitiveness or a “did you know about VBAC?” attitude).