Thursday 2 January 2014

5 reasons why I've fought so hard for my vbac

**Disclaimer
(I started writing this post at about 38 weeks, when if I was having an RCS, I would have been going in really soon. It has taken a while to get all my thoughts typed out, so I am finishing it off 3 days after the birth of my little girl. Please excuse any continuity discrepancies as a result of this!)

The more I think about my decision to attempt a vbac, the more I am convinced that I am doing the right thing - the only thing - that makes sense for my family and I. I have had people tell me they think I am crazy, and others terribly concerned that I am doing something very dangerous. I respect these concerns, but my research has shown over and over that it is not nearly as dangerous as we are lead to believe (particularly in South Africa, with our scalpel-happy birth culture), and that far from being a crazy option, unmedicated natural birth is the best and safest option for mom and baby.

I realise that some women will take offense at what I have to say. Please understand that I make no judgement on anyone else's decision. I do however have serious issues with doctors who don't ever explain that there is another option - and that justify unnecessary caesareans (whether they may be a woman's first or a repeat) by scaring a woman with the terrible  consequences that would have resulted if she had not had it ... and the label 'emergency caesar' that gets thrown at the c-sections that are done only too readily.

It is true that some c-sections are genuine emergencies. But the World Health Organisation recommends a maximum of 10 - 15% of births be done by c-section (to maximise mother and baby health), so you have to wonder why South Africa is so different that 70 - 95% of births in private hospital 'have' to be by caesar. The very label 'emergency' makes most women believe that their caesar was totally necessary, when in fact so many are merely as a result of an obstetrician's impatience, desire for his own convenience (rather than what is best for mom and baby), and his arrogance in assuming that his surgical skills are a better method of birthing than the way we were designed.

So many women just assume that their gynae (technically they are obstetricians when talking about pregnancy and birthing, but in South Africa we tend to refer to them as gynaes, and so I will stick with this practice out of habit) knows best, is up to date with research and only makes recommendations based on the best interest of her and her baby. Gynaes are only human! The greatest lesson I have learned in my vbac journey is that gynaes are not infallible. Sometimes those considered the 'best' in a city/hospital are actually those that are the most human, and make recommendations based more on their convenience (and human opinion) than on evidence-based medicine (and medical opinion).  I long for the day when women make their OWN decisions about what is best for their child's birth, rather than simply accepting a gynae's opinions as fact.

Reason 1: My baby will come when she's ready *
All scheduled C-sections are too early. Simple as that. Some babies will have complications because of it, some won't. But the fact remains that if you haven't gone into labour, your baby was not yet ready to be born.

Some of the more common problems that babies have are respiratory distress and jaundice. Although babies are technically term from 37 weeks, they are only classified full-term from 39 weeks. Many countries will only schedule repeat c-sections from 39 weeks at the earliest (most from 39+3 or even 40 weeks) unless there are valid medical reasons for an earlier delivery, South African doctors are only too happy to schedule them from 38 weeks. By 36 or 37 weeks we generally feel huge and exhausted, and are only too ready to be un-pregnant again. Our doctors are only too happy to pander to this by suggesting we have our babies early to avoid the 'danger' of going into labour.  No doctor ever tells us that it would be better for our babies to come on time rather than early, that there are still risks after 38 weeks (and in fact, no doctor would even admit that 38 weeks is actually early - despite the fact that only 50% of women go into labour by 40 weeks including premature babies, and the average first-time labouring mom will only go into labour at 41+3 weeks), and that our comfort is often at the expense of our baby's health.

Babies born between 38 and 38+6 weeks are twice as likely to have breathing problems than babies born after 39 weeks. (Babies born from 37 weeks are 4 times as likely to have breathing problems).

Plus, due dates are at best an estimate. Even going by your last menstrual period (or LMP) can be out a few days, because we all ovulate at different times - and every day counts!

Certain antibodies are only transferred in the last weeks in the womb, so babies that are evicted before their time is up lose out on these antibodies and the protection they provide.

The church I go to starts at 9am on a Sunday morning. Some people are there by 8:50 or even 8:45 to park and get a good seat (or just because they like being on time). Most people arrive at or just before 9:00. My husband and I are usually late, and so we can arrive there anytime between 9:05 and 9:10 (and even later some days - the day I was in labour, we arrived at 9:20!). Taking babies out at a pre-specified time because they 'should' be ready by then, is like saying that everyone who attends that service should be there at 8:50. If we were somehow transported to church at 8:50am on a Sunday morning, we would probably still be in our pyjamas, eating breakfast. One time just doesn't work for everyone, even though we all aim for 9:00. Same thing for babies.

Reason 2: Labour hormones are GOOD for my baby *
Hormones released in labour help protect baby's brain, prepare her lungs and build her immune system, as well as helping baby to imprint on mom and assist with attachment and bonding.

Oxytocin is a feel-good, bonding hormone that is released during and after birth for an hour or more. It helps mom and baby learn to trust each other as well as feel calm and happy. It also acts in mom's brain to initiate affectionate maternal behaviours.

Pitocin is an artificial version of oxytocin and is used in inductions. However, it doesn't cross the blood-brain barrier. If no anaesthesia (eg by epidural - or in a C-section) is used then mom's body will still respond by releasing oxytocin during the birthing process - and so labouring before a C-section has some significant benefits, especially for baby. No oxytocin leads to an increased risk of postnatal depression as well as more difficulty in bonding. Oxytocin will still be secreted after a C-section while breastfeeding, but it remains low for at least 2 days after birth, which tends to increase mom's anxiety and decrease breastfeeding success.

Reason 3: C-section risks for baby
A lot of these risks are interlinked, and so some information will overlap between paragraphs.

Earlier I mentioned the increased risk of respiratory distress in babies born before 39 weeks. One of the hormonal and physical consequences of labour is that fluid from baby's lungs is absorbed. In babies born via C-section without the benefit of labour beforehand, there is a 4 times higher risk of breathing problems (assuming both babies are the same gestational age). This may be a contributing factor as to why C-section babies are twice as likely to suffer from allergies as vaginally-born babies.*

I also mentioned earlier that a number of antibodies are transferred from mom to baby in the last weeks of gestation - even more antibodies are transferred during labour, helping to protect baby by providing some initial immunity and a healthy gut system (a good reason to give your baby probiotics if you ever need a C-section). This may contribute to the fact that babies born via low-risk elective C-section (including RCS) have a tripled death rate in the first month of life compared with vaginal births.*

The risk of a c-section baby dying of SIDS is also significantly higher than that of a vaginally-born baby, which is probably connected to the increased risk of breathing problems as well as decreased immunity. A study carried out on rats showed that compression (i.e. from labour contractions) had a huge effect on breathing - rats were delivered via c-section and then either subjected to compressions (similar to those experienced during labour) or not. Those who underwent compressions were all still alive after an hour, whereas a number of those who were not compressed died fairly within the first hour. *

C-section babies are also at risk of being cut by the obstetrician's scalpel as s/he cuts open the uterus, although none of us like to think about it. 0.1 - 3.1% of babies born via c-section will suffer from lacerations due to surgery.

Anecdotally, I took my daughter to both a chiropractor and a kinaesiologist to help with her wind, colic and allergies. Both of them said that they see virtually only c-section babies. In particular, the chiro said that c-section babies are pulled instead of pushed out, and this regularly causes some spinal misalignment, which can result in general pain or cause gas bubbles to become trapped (because they cannot travel through the baby's system quite as easily) which can be very painful for a little baby. So next time your newborn is gassy or just plain miserable, it may be worth taking them to see a chiro - they can make a world of difference.

Reason 4: C-section risks for mom
First up, I am 3 - 11 times less likely to die from a natural birth than a c-section, depending in which study I use. That's a lot, no matter which way you look at it.

I'm also less likely to suffer a heart attack, need a hysterectomy, stay in hospital for longer (or be readmitted to hospital later as a result of a C-section), get a hematoma, struggle to recover (with the exception of haemorrhoids, which are more common after a vaginal delivery) or have long-lasting pelvic pain.

Plus, I'm also less likely to have painful sex after a natural delivery. Yes, that sounds like it makes no sense! But 40% of women who have had a caesarean delivery suffer from dyspareunia (pain during sex) after birth (which may last up to 6 or even 12 months after the birth), compared to only 26% of women who have given birth naturally.

Reason 5: I don't want major surgery unless really necessary!
This seems like a bit of a no-brainer to me! Just because C-sections have become routine here don't make them a simple procedure! They are still major surgery and so carry all of the general risks of any major surgical procedure, namely anaesthesia complications, bleeding problems, blood clots, risk of death, delayed healing, difficulty breathing and risk of infection.

I accept that giving birth involves pain of some sort. However, I'd rather deal with that pain before my baby arrives, rather than afterwards. I don't want to have to be in pain with a newborn and a toddler to take care of, unable to pick up my toddler because she's too heavy, unable to drive for 6 weeks, hobbling around, sore and yet still drowsy from the pain medication.


The honest aftermath - my feelings after my vbac
3 days ago, I got my vbac. It was hard work, far more intense than I had imagined. It took all day, from 3:40am until 2:10am the next day. That's a long time! It was seriously painful at times. I doubted whether I could do it a number of times. I got a second-degree tear and 9 stitches. That was really sore afterwards, and is still quite tender now. That's the bad side of it.


But the exhaustion gave way to elation and euphoria as soon as I gave birth. And that euphoria was also far more intense than I could have imagined. I went home the following day - I've been home for 2 nights already, whereas if I had a c-section, I would only have gone home today. I got up and showered as soon as I handed my baby over to be measured. I drove the day after I gave birth - without feeling like a rebel ;-) I pick up my toddler and cuddle her as much as I (or she) wants. And that tear hurts, but nothing like a c-section incision. I'm not drugged up on pain medication.

I felt and watched my baby come out from me - she felt like MINE from the instant I saw her. Then she was put on my chest and we just hung out together and gazed into eachother's eyes (and started breastfeeding as soon as she started rooting) for a couple of hours. No rush to bundle her up and take her off to be weighed and assessed. It was peaceful, at her pace (and mine), intimate (darkened lights, warm water) and most of all, it was just so real. My baby is alert, feeding well and is peaceful - can I say that all of this is from her birth? Of course not. But its hard to not compare this to my first, who was so sleepy from the anaesthetic that she struggled to stay awake long enough to feed for the first few days.

It was probably the hardest thing I have ever done, physically and emotionally, after fighting so hard for it and having so much invested in succeeding. But it was also the most rewarding, healing, triumphant, amazing experience. I could keep trying, but there are no words to describe what I felt then and still feel now at the memory of it. It goes so far beyond meeting your baby for the first time.
 

1 comment:

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