VBAC Mamas, Unite!

I'm a proud VBAC mom. My first birth was a cesarean. Luckily, my next birth took place during the VBAC renaissance, and even though they were whispering in the corner about a repeat cesarean, it didn't happen. I had my first vaginal birth accompanied by a giant episiotomy. That didn't stop me, though. My next VBAC had no episiotomy. The VBAC after that, the doctor almost didn't make it in the room to catch in time. By that time, I'd had enough. My next four VBACs were at home with midwives. Seven successful VBACs.

Women today rarely get the opportunity to even try a VBAC. Hospitals ban them. Doctors trick women into thinking they can have one and then pull the rug out from under them late in their pregnancies. Yet the evidence shows that VBAC is still a safer route to go than repeat cesareans.

This week, the National Institute of Health (NIH) has had a panel meeting to discuss this very issue. I haven't had the opportunity to listen for myself yet, but I've been reading the comments posted by others, outlining the "Hurray!" moments and the "I can't believe they still ignore us" moments.

On the WebMD site, David DeNoon reports, "Hospitals and professional societies should end bans that that keep many women who've had a C-section from opting for a natural birth in later pregnancies, an NIH advisory panel today urged." This is definitely a welcome beginning.

Kenneth Lin, a family practice physician from Washington DC, writes about the obstetrical tendency to see zebras instead of horses. He writes, "If an Ob/Gyn is feeling uncertain about how well a patient's labor is progressing and has an inflated estimate of the probability that something might go wrong (the zebra), it's very hard to resist the temptation to eliminate the uncertainty by delivering the baby surgically, then and there." He ends his article positively with "a trial of VBAC is successful more than 75 percent of the time. It's a real shame that women in the U.S. are discouraged from attempting them more often."

All this sounds great. Maybe women will get more opportunities to have their own VBACs. Maybe the cesarean rate will go down. Maybe... but then we see the extra caution thrown in. "Only qualified candidates" and "eligible patients" are the phrases that begin to crop up. Isn't that part of the problem now? Obstetricians are removing almost every woman from being qualified or eligible. Let's just schedule that cesarean... what do you say? You can pick a convenient time (for the doctor!) and we'll have your baby out in no time!

Kind of defeats the whole purpose, doesn't it? The real result is shown clearly by Courtroom Mama on Jill's Unnecesarean blog. Apparently, on day one, two members of the panel, Dr. Anne Lyerly and Dr. Howard Minkoff stated without hesitation that a woman could not be operated on against her will. The next day, when Susan Jenkins, the attorney for the Big Push for Midwives campaign, asked questions about this, the panelists ended up skirting the issue.

Here is a portion of Courtroom Mama's transcript from her post. Read the full article at the link above to the Unnecesarean blog. SJ is Susan Jenkins. LM is Larry McCullough, the ethicist on the panel.

"SJ: Dr. McCullough, just one quick follow up question, if I may, on that. The conclusions that are reached in the draft, at least the draft opinion that we saw this morning, indicate that the position of the committee is that only where it is considered “medically reasonable”—whatever that means—would the woman have a right to refuse. And the definition of medically reasonable…well, there is no definition of medically reasonable.

LM: Well, actually, there is, and the concept is when the alternatives are roughly medically equivalent. What we said is that shared decision-making should be followed, where the physician refrains from making a recommendation and really helps the woman make a decision that reflects her values and preferences, which is the goal of the informed consent—

SJ: Right, and what if her values and preference is to say “no” at the end of all this?"

Ms. Jenkins was then reminded of the long queue of people wanting to ask questions. Just what is "medically reasonable"? According to who? Apparently not according to the mom in question. Informed consent seems to have just been dumped into the trash. Pregnant women obviously don't have the same rights to equality as other medical patients. 

While we all joke about "pregnancy brain" it isn't something that should remove our rights to bodily integrity and decision making once we check into the hospital or accept a doctor's care. All the talk the panel made earlier of "the doctor and woman should be making these decisions together" seems to have been to placate the masses of women hoping to have a vaginal birth. "Making decisions together" is just another euphemism for the doctor saying "Don't worry your pretty little head about it... we'll just cut that baby right out. You won't need to even break a sweat."

I think this panel brought up some great points. It has gotten articles about VBAC in major papers like the LA Times. But we can't stand idly by and let it turn into the same old line. VBAC mamas, unite! Let your voices ring out. Demand the right to birth your babies the way nature intended. Every baby deserves the best birth possible. Every mom deserves to give birth.