Saturday, February 6, 2010

A Happy VBAC

I am just home from a lovely VBAC, which couldn't have happened to a nicer family. I believe it is going to generate a lot of healing.

I get a perverse thrill when I have lady have a VBAC that defies medical expectation. Her primary care doctor was a family physician who is a huge supporter of VBAC, and was very much on her side. But the Obstetric team needs to be involved with a VBAC as well in this hospital, and while it provides a safety net, it also creates some tension. The team came into the room and laid out the stats and the way they wanted things to progress in order to avoid a repeat section. Now, I know they were just doing their jobs responsibly, and the way in which the information was relayed was kind, positive, and supportive. But there was also a pressure to perform. Birth doesn't always respond well to performance anxiety. I worry that when something is held with an expectation to fail, the energy can have a tendency to follow that thought, and I have to work hard to buffer that vibe and keep a reasonable amount of faith going.

One thing doctors are very concerned about is obstructed labour. Of COURSE they are, when they are responsible for a woman and baby's health. It is true that an obstructed labour can increase the risk of uterine rupture during a VBAC attempt. But what this translates as is this: "If you don't follow the curve in a timely manner, we will diagnose obstructed labour, and you will be sectioned to circumvent disaster." As we've already discussed in past blogs, Friedman's Curve drives me bonkers for a variety of reasons. Is a VBAC labour which doesn't go along with the curve TRULY and ALWAYS obstructed?

I ask this because one thing I have witnessed with VBAC, and I have attended MANY VBACs, is that it is actually normal for there to be "stalls" here and there, even more so than in regular labours. Just to throw out a number, but I find it is not uncommon for a woman to hang out at 5cm or so for awhile (though this number is arbitrary..I've seen it at 2cm, as well as at 9cm). Sometimes for quite a long time. Instead of this being automatically construed as a pathology, could this not possibly be Nature's way of helping the uterus gently adjust and adapt to its surgical incision? I'm just thinking out loud.

Obviously I am not making a medical opinion, as I'm not in the position to give one. Obstructed labour is said to lead to uterine rupture in childbirth, but the one rupture I have seen seemed quite directly caused by Synto augmentation to ensure things "hurried" along to "fit" the curve. This one incident obviously doesn't prove anything at all, and my experience and statistics cannot even scratch the surface of those of a doctor's. But it does make me go hmmmmm. I guess I am luckier than most doctors to have seen several out of hospital VBACs, and the gentle, trusting way in which they're held by midwives. We encourage the woman to rest and gather her strength during the ebbs, without trying to stimulate things with aggression. I'm not saying that all VBAC attempts stalled for a long time should just be ignored because it's always normal...I wouldn't want anyone to come away with this message. But I would like to take a closer look at the commonality of ebbs in VBAC labour, and reconsider whether or not venturing outside the curve necessarily smacks of potential rupture. Just a thought.

Anyhoo, today's VBAC was awesome, because it was one of those births the medical establishment was not super comfortable with, but it was a success and it made everyone happy. The mother had been sectioned her first labour after many hours of active pushing (however, according to her, she was made to push for a lot of that when she doesn't even think she was having contractions), which "reduces" the chance of subsequent vaginal birth. Also, that baby was over nine pounds (doctors don't love babies being that big...and second ones are potentially bigger, so VBAC attempts with a big baby birther are looked upon with a wary eye). The mother, coming jjuuuuust under the curve by an hour or two was starting to get the hairy eyeball. So we took off into the jacuzzi room to avoid too much outside influence. To make a long story short, the baby came down really fast and was born vaginally at 9 pounds, even though they were expecting a smaller kid. In the end, we were grateful for a little technical help for some fetal distress and sticky shoulders, but a triumph all around.

One of my favourite VBAC stories is of a client of mine who was sectioned with her first birth (at which I was not in attendance) after pushing for many hours, and just not able to move the baby out (she had an epidural). Well, not only did she have a VBAC for her second baby, but she had it unassisted over her toilet after an extremely quick labour. The baby was bigger than the one who was sectioned for being "too big" for her to pass. I am blessed to have lots of stories like this..more stories which shatter this myth that about every second woman has a pelvis too small and too inadequate to pass a baby (oh if I had a dollar every time I heard this statement), than ones of true CPD.

An immature, rebellious little part of me wants to thumb my nose at those who were naysayers and do a happy dance when I see these "miraculous" births... but when I look around at the doctors, they're usually doing happy dances too, because it makes them feel good to have their patients feel triumphant about their births. When all ends well and the mother is thrilled and grateful, these stories plant seeds for change, and everyone celebrates.