When I began seeing my doctor for prenatal services in June, I was surprised and a little overwhelmed to find out that my hospital had reversed its policy forbidding vaginal births after a c-section (VBACs), and was now encouraging the practice.  I knew I would have myriad issues to consider, and that I needed to spend a very long and serious amount of time trying to decide what was the best option for me birthing-wise. 

Now, having just entered my third trimester, I’ve finally come to a conclusion.  I’m having a repeat c-section.

Shocked?  I sort of was, too.  In fact, I was very much considering not writing about it once I made my decision.  I’ve read all of the material on VBACs I can get my hands on.  I know that the American College of Obstetricians and Gynecologists are fully behind VBACs unless there is a medical reason to avoid (like an induction, which increases the likelihood of uterine rupture).  I even know that VBACs are successful in most cases, and that the risk of uterine rupture is less than one percent.

I had discussed all of these facts with my general practitioner, who was overseeing the beginning of my pregnancy.  But because he cannot do a VBAC delivery, I was recently transferred to my OB/GYN for the duration of the pregnancy, and once more went back through my thought processes on delivery.

I trust my OBGYN implicitly.  When I learned I miscarried in October, he arranged for my D&C, coming in on a Saturday (and Halloween) in order to get me through the process as quickly as possible.  He walked me through numerous follow-ups as my hormones took months to get back to a “non-pregnant” state, was a supportive cheerleader in my efforts to come up with a plan to become pregnant again.  Appointments with him always became less about physical stats like blood pressure or weight, and more of a discussion about my emotional health and needs.

As we began to discuss the delivery, I was reminded of an exercise that we did during our parenting class before Violet’s birth.  We were given a stack of paper slips that had words like “epidural,” “induction,” “c-section,” “episiotomy,” “healthy baby,” or “no pain medication” on them.  We were instructed to pick the ones that mattered most to us,  eliminating them one by one until eventually we ended up with just one slip of paper, which, of course, read “healthy baby.”  Because in the end, that’s what every parent wants most.

I remembered the instructor laughing at me when we had narrowed it down to three, since my top three were “no c-section,” “no episiotomy,” and “healthy baby.”  I told her that I was willing to put up with any pain that was thrown at me, I just wanted to avoid anything that would make my recovery slower after the labor was over.  After all, how long could labor go?  Once it was done, at least it was finished, no matter how awful it is, right?

Like most moms, I went into labor with a birth plan — one that already went right out the window when the started the induction.  By the second day of the induction, after 12 hours on pitocin and still no dilation to show for it, the vow to avoid the epidural went by the wayside, too.  We would have stopped the induction all together and tried again the following day if my water didn’t decide to break the moment I got up out of the bed to change my clothes and go home for the night.

All I wanted, once we got down to two slips of paper in the parenting game, was no c-section and a healthy baby.  In the end, I didn’t get my wish for either.  I had an emergency c-section about 18 hours later and a baby in the NICU for 10 days due to infection.

This all came back to me as my OB/GYN asked me once more, what was most important to me about this birth.  I realized that I didn’t care about the labor, and I didn’t care about pain management, and in the end, I didn’t care even about the birthing process at all.  All I wanted was to do everything possible to ensure that this baby gets a better start than his sister did.  I want to eliminate all possibility that he could contact group b strep, of which I am very likely still a carrier.  Part of giving him a better start is ensuring that I, too, do not end up in another failed labor situation, with my own infection and massive blood loss impeding my recovery, as well as my body’s ability to perform basic functions like make breast milk.

The odds are totally in my favor that I would have a successful VBAC.  Yet the odds were even more in my favor to have a successful vaginal birth with my daughter, and I most definitely did not.  With one failed labor in my past, I already had one more strike against me than last time.  Did I really want to risk it again?

As we talked through all of my concerns, I admitted to my OB/GYN, “You know, part of me almost hopes that when we get near the end, the baby is actually breach so the decision is made for me and I can just have the c-section.”

“If that’s really how you feel,” he responded, “I think you’ve actually already made your decision, you just need someone to tell you that it’s a valid one.  And for you, I think it is.”

So the date is set.  I will be having a baby on December 10th, two days before my daughter’s third birthday.  In fact, the process is expected to be so simple that, should no complications arise in the first 24 hours, my OB/GYN has suggested giving me sutures rather than staples so that I can leave the hospital early and be home for her birthday.  Considering my last c-section ended in infection, a near transfusion and extended hospital stay, I couldn’t be more pleased to have an orderly plan that is organized to maximize the recovery time for myself and my new baby.

I know that a repeat c-section isn’t the right choice for everyone, but it is for me, and for my medical history.  I am still an advocate for VBACs for any woman who wants one and who feels that birthing vaginally rather than surgically is the better labor choice.  But having weighed the risks and benefits, that is just not me.  And, just as women need to speak out to have their rights to attempt a VBAC accepted as an option among the medical community, I feel it is just as important for me to explain why I was open to the possibility but in the end made a different choice.  The important part is that we are all allowed to make our own, informed choices, and be advocates in our own health.

It wouldn’t, however, be fair of me to write this article without admitting one additional fact that was in play when it came to my decision to chose a c-section.

Insurance.

It’s an issue that many women with due dates in December have to examine.  With higher co-pays and out of pocket deductibles, the cost of having a baby in a hospital can be high, even if you have coverage.  For us, we know that our maximum out of pocket expense for the year is $6000, something that we have come to terms with and planned for.

However, with a due date of December 17th, allowing things to proceed naturally could put us in the worst possible situation: having a hospital stay that would straddle two calendar years, in effect doubling our out of pocket costs. 

It shouldn’t be this way.  You shouldn’t need to factor in whether or not you can afford to pay your portion of your care when deciding what sort of health care procedure you need.  Giving birth should not have the possibility of costing as much as a new car, or a down payment on a small house. It’s ironic that I’m choosing a more expensive procedure in part to ensure that I can actually afford to give birth to a baby. 

I guess once again we are learning that health care reform only brings so much to the table when it comes to making health care accessible and affordable for all women’s needs.