Q: I have a one year old baby and recently found out I am expecting
another. I had a c-section (no choice of mine) with the first baby. My
doctor said that a c-section is definite with this one. Is it true that I
don't have a choice in the matter? Second, If not, then I would love
nothing more than to have my baby at home. Is this possible?
-Elena Moreno
A: I belong to an email list called HBAC (home birth after cesarean). We
have many women on the list who've had home births after cesareans; one had
a homebirth after *4* cesareans! Yes, it is possible. Join us at
www.onelist.com. Just search for the group called "hbac."
As for your doctor, I'd seek a second opinion. We always have choices in
our healthcare options, though we often have to be the ones to seek those
choices out.
-Victoria
====
A: It is not possible to give a responsible answer regarding the safety of
having a vaginal birth following a caesarian without knowing both the
reason for your cesarean and the method used to perform the operation. I
suggest you return to your doctor and have him or her explain these to you.
Once you have this information, if you are unhappy with the rationales you
are better placed to seek a second opinion, be it medical or midwifery
based. A few tips: Ask your friends if they know any doctors or midwives
who are sympathetic to the idea of a VBAC, and if and when you talk to
these people, be totally honest with them.
-Jacinta Muller RM
====
A: ...I think that by questioning our caregivers (doctors and midwives!)
about our health, we are demanding that they be accountable for their words
and decisions and we are showing that we are involved and caring about what
happens to us in pregnancy and labour.
-Jennifer White, Nova Scotia
====
A: If you read the research surrounding the issue, the risk of a ruptured
uterus is no more than the risk with a first time labour. Encourage your
baby into the optimal foetal position. When a baby is in the correct
position it is amazing how easy the labour is even when the baby is quite
large. Also research was conducted in 1987 that stated how important it is
for the baby to experience labour in order to build its own endorphins for
survival outside the womb. Babies had six times the level of stress
hormones on board following birth than that of someone experiencing a
stroke. That gives them an incredible start in life. Research also
indicates that babies born by elective C/S tend to give up easily in life
and don't have the staying power. Babies born by C/S have a higher risk of
respiratory problems. Even if you need another C/S it is important to
labour first; so what if your doctor has to be called out in the middle of
the night to do the C/S. Elective C/S are mainly for doctors' convenience.
If baby ends up needing a C/S at least a mom knows she has given it her
best shot and the baby has the necessary endorphins.
We recently had a client who presented with a frank breech--both knees
either side of the cervix. She had a lot of pressure to have an elective
C/S, but she stayed strong and waited until she went into labour first.
This meant her baby was ready and she was ready. When she went into the
hospital she also set the operating theatre up with music and made sure the
screen was down so she could see what was happening and see the birth of
her son. As soon as the baby was born it was handed to dad, he put the baby
immediately down his overalls so that the baby has skin to skin contact and
remained warm. Mum fed baby whilst she was being stitched up. I have never
seen a happier mother following a C/S--she said it was as close to a
natural birth as she could get. The experience you have will stay with you
for the rest of your life.
-Vicki
====
A: Some of the issues to address here are: having sufficient support from
others to go natural; having confidence in the wisdom of your body to birth
naturally; yourself being confident and relaxed enough with going a route
which fallible authority figures called doctors often do not seem to
support; how much of your life is governed by outer authority figures as
opposed to what you really feel is right deep within you for you.
-Bruce Mitchell
====
A: VBAC is called a "trial of scar" and is successful in at least 50% of
women who chose to try it. A trial of scar does carry with it a degree of
risk and because of that, you would be best to labour in hospital.
Remember, this is only one opinion, just as your doctor has only one.
-Kelly Chisholm
====
A: As a homebirth midwife I am happy to assist women to have a homebirth
after a C/S. In most instances the women have had beautiful births with no
difficulties. I always watch closely, listen well to mother and baby,
transfer early. For me there is no difference in the support of a woman
birthing after a C/S, for this is how it should be for every woman.
Sally Westbury
Australia
====
A: Read Henci Goer's new book "The Thinking Woman's Guide to a Better
Birth," Cohen & Estner's "Silent Knife: Cesarean Prevention & VBAC," Nancy
Wainer Cohen's "Open Season: A Survival Guide for Natural Birth and VBAC in
the 90's," Johanne C. Walters, Karis Crawford's "Natural Birth After
Cesarean: A Practical Guide," Diana Korte's "The VBAC companion." Hire a
doula. Contact ICAN--International Cesarean Awareness Network
www.childbirth.org/section/ICAN.html
-Chrys Holland,
====
A: I had a c-sec on my second pregnancy (a planned homebirth) for
pre-eclampsia. Of course, I was told (in the hospital) that I would never
be a candidate for homebirth but just 20 months later I had the fabulously
empowering experience of a homebirth. I am so grateful that my independent
midwife was prepared to study with me to see just what, and how big, the
risks were. (It was her first VBAC). I guess if we had had to go to
hospital it would have taken 40-60 mins. I am quite certain that in
hospital I would have been over-monitored and not allowed to relax into my
labour. Some of our closest hospitals now have a c-sec. rate of 20-25%.
-Monica O'Connor
Home Birth Association of Ireland
hba@iol.ie
====
A: It has only been a year since the c-section so you may have added risk,
but definitely go for what YOU want. It can't ever hurt to ask.
-SM Reed
====
Reprinted from Midwifery Today E-News (Vol 2 Issue 15 April 14, 2000)
To subscribe to the E-News write: enews@midwiferytoday.com
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