In saying that, I have come a long way in the past 7 & a half months with regards to my mindset and I’ve realised that what is most important for me, is just to go into labor naturally. I want my baby to choose his own birthday, to be ready to join the world, and for my body to be ready too. I’ve realised that in some ways a Caesar is ‘nicer’ if I can put it that way (no tearing/cutting, a longer stay in the hotel ahem I mean hospital) but the recovery time is much longer than a natural birth, and trying to recover from a second c-section, feed and care for a newborn AND look after a busy toddler is not going to be easy.
VBAC’s in South Africa
Just a little note…these are my own thoughts & perceptions from months and months of research & spending time chatting to care providers and other moms, I am in no way bashing the health system here, but rather sharing my own personal views.
South Africa, in general, is not very VBAC friendly. Most gynaes are not very keen on the idea (I say most, because up until recently I didn’t even know that it was an option to try for a natural birth after having a ceasar as it’s not something the majority of gynaes support). I am generalising, as there are some incredible VBAC pro gynaes out there, but they are few and far between, and there are lots of reasons for this.
First of all, most gynaes will tell you that the biggest risk of a VBAC is your uterus rupturing. While there is a chance of this happening, the actual statistics are soooooo tiny (it’s less than 1%), and there is only a slightly lower risk of this happening even with a regular, first time vaginal birth. Anyway, this post is not supposed to be a rant on gynaes and their choices to avoid ‘risk’, but rather to share my feeling and decisions in wanting to pursue a VBAC.
There are also lots of factors that affect a positive outcome for a VBAC, and a lot has to do with the reasons why you may have had to have a Caesarian in the first place, as well as the type of scar you have (these days its most common for a Low Transverse Incisions to be done…this is from the top left and across). If you had an elective caesar the first time around, there is no reason why you shouldn’t be able to birth naturally. If, like me, you had an emergency caesar, it can change things a bit as your doctor would worry about whatever happened to prevent a natural delivery the first time, happening again.
If you are wanting to explore the option of a VBAC further, I would HIGHLY recommend joining the VBAC in South Africa facebook group. There are loads of wonderful ladies in that group sharing their experiences, their VBAC successes and failures, as well as LOADS of information of VBAC’s here in SA.
Did you know that Government hospitals will push for a VBAC due to the immense cost & labour (ie staff required) of caesarians, preferring for the mom to rather attempt a natural delivery than have a repeat caesarian. This really should highlight just how normal the idea of a natural delivery after a c-section is.
Here in South Africa, most gyna’es have a very strict tick box list for a VBAC in hospital (these may vary slightly, and some gynaes may differ/be open to changes but these are the general guidelines:
Baby must weigh 3.5kg’s or less at birth
You must go into spontaneous labor (ie your body has to go into labor naturally) by 38/39/40 weeks
Labor has to progress by 1cm an hour
There should be at lest a 2 year gap between your last birth and your current due date
From what I have read and from the many, many ladies I have spoken to about this, the highest chance of a successful VBAC is to have a home birth with a midwife & a doula. While I love the idea of a home birth, I’m not sure it would be something I would actually pursue, and the fact that I live 1.5 hours from the nearest hospital basically rules out that option, especially for a VBAC, when most midwives wouldn’t attempt a home birth for a VBAC as if things do go wrong, you need to be able to get to a hospital as fast as possible.
Your second best chance for a successful VBAC is a hospital birth, but with a midwife as your primary caregiver, and a Gynae as backup. This is a tricky one, and unless you really strike it lucky with a Gynae who agrees to be ‘on stand by should things go wrong’ it’s not easy to make happen. It’s different if you live in Joburg or Cape Town, as then you have the option of a clinic like Genesis, which is midwife led, and whose whole focus is on a natural delivery. I visited Genesis in Joburg for my second trimester abnormally scan, and it was just the most incredible place. I even considered moving in with my family in Joburg for the last few months of my pregnancy, just so I could give birth there…but then came to my senses when I had to ask myself if would really be happy being away from my husband for those months, and also would he be happy to be away from me and his little girl during that time.
Third option, and the one I have had to settle for due to my own personal circumstances (basically, the fact that I live out in the middle of nowhere!) is to have a hospital birth with a VBAC pro gynae. There are not a lot of options for VBAC pro gynaes in Pietermaritzburg, and in my months of research, have realised there is a big difference between a VBAC pro gynae and a VBAC friendly gynae. A VBAC friendly gynae is open to the idea, but they are far more risk adverse than a VBAC pro gynae, and the chances of a successful VBAC are much lower. Anyway, beggars can’t be choosers, and I have found a VBAC friendly gynae (she was the gynae who actually delivered Everly as my doctor just so happened to be overseas when I went into labor) and so as she actually did my surgery, I decided to go with her for my second pregnancy. She was very blunt with me in the beginning, not saying no to a VBAC, but not being very hopeful either. She just told me we would have to see how my pregnancy progressed, and gave her strict list of labor protocol. I left every check up with her ( up until about 28 weeks) feeling despondent, and not at all hopeful for my VBAC. I even considered changing gynaes several times…I just wanted someone to give me the chance and to be encouraging and positive about a VBAC. I wasn’t looking for anyone to make any promises to me (after all…I have first hand experience of how things can change during labor) but she was very honest and pragmatic about the whole thing, and I really respect her for this now. She didn’t want to give me an false hope, and I’ve realised it’s not her job to feed into my birthing fantasy, when she knows there is no actual way to know what will happen during your pregnancy, never mind during the actual birth.
I think the guidelines above make it pretty much impossible (if followed 100%) to have a VBAC. First of all, the weight scans during check ups are estimates…Everly was estimated to be 3.5kg’s at birth and was born at 3.085. Not many women (generally speaking) actually go into labor naturally before 40 weeks…many are induced (something that is not recommended for a VBAC as labor can progress very quickly once induction has taken place, and this places a greater stress on your scar tissue. For labor to progress by 1cm an hour is pretty much ideal textbook stuff, and not likely that most women’s bodies would follow this ideal. The age gap stated is to give your body and scar an adequate amount of time to heal, but some women heal faster than others, some scars heal better than others, and so this is a very hard guideline to follow. I have heard most midwives prefer an 18 month gap, and no less. But then again, there are always exceptions and I have read about amazing mommies who have had successful VBAC’s with a 11/12/13 month gap. My gap will be about 17.5 months if baby arrives at 40 weeks.
It was at my 28 week scan when my Gynae told me that although she does elective caesars at 38 weeks, she was willing to make an exception and allow me to go to 39 weeks for spontaneous labor. I was happy to compromise on this, and considering Everly arrived at 38 weeks (and apparently second time labor is likely to be early too) I felt confident that my labor would begin before then. If not, I agreed to set a date for my repeat caesar. I have just gotten back from my 33 week check up, and Doctor was very happy with how things are looking and has told me, that as long as everything is else is in order (ie no complications, baby is in the right position etc) she is happy to let me go to 40 weeks. I am delighted with the news! So, according to my original due date, I’ve got until the 22nd Feb to go into labor naturally. I will be doing ALL the things to try and ensure this happens, but as I mentioned above, I am far more at peace with a repeat ceasar that I was before and now will just have to wait and see what happens in the next 6 weeks.
I’ve got my wonderful Doula, Clare, at the ready (Clare was by my side through my entire labor with Everly and I know I would not have been able to make it as far as I did without her) and was one of the first people I told I was pregnant this second time, and told her to make sure she had a note in her diary for mid/end Feb! All that I can do now is wait, stay healthy, keep active (do my kegels, bounce on my Pilates ball) and be patient.