Birthing Plan

I have been thinking more about the delivery of bun 2. I had, when I first got pregnant, assumed that I'd have to do a Cesarean birth again. I remember asking John, who is an OB/GYN about this point soon after we had Zoe by Cesarean birth. He had said that about 80% of patients are directed to have a second C-section. However, on the day Dennis and I told our pregnancy to John, he mentioned that the policy/guidelines regarding VBAC (Vaginal birth after Cesarean) is under debate again. It appears that there is some rethinking about VBAC and the risk assessment regarding the primary reason for shunning it - primarily uterine rupture at last cut - as well as the costs and risks of repeat Cesarean birth. He spoke strongly of studies indicating the high risks of repeat C-sections, and the benefits of vaginal birth for both the mother and the child.

I want what is good for my child and myself, which means I should attempt a VBAC. Luckily for us, Kaiser is fairly supportive of VBAC. And the doctor I have been seeing - Dr. Beecher - is not opposed to it. (Apparently, some insurance does not allow it and some hospitals' malpractice insurance forbids it too. Interesting, considering how C-section is so much more expensive than vaginal birth. Most women who have had a previous Cesarean birth do not end up with vaginal birth the second time round. Here, most is at about the 90%, according to the National Institute of Health. That's a huge number. But it hasn't always been this way. Back in 1996, nearly 3 in 10 women (or 28.3%) who had a previous Cesarean birth managed to give birth through the vagina. What changed between the years?)

Anyhow, we discussed it and the current plan is for us to try a VBAC if I go into natural birth by due date, and to schedule for a Cesarean birth should I go over due date. Induction is no longer a possibility as the chemicals used for inducing babies apparently lead to high incidences of ruptures, which is vastly dangerous for both mother and child.

Since I did more research on this topic and having talked to my OB, I regret that I allowed so much intervention in Zoe's birth. I've learned that Pitucin - the drug used to induce labor - causes stronger contractions that actually stresses out the baby. The stronger contractions leads to more discomfort and more intense pain, which then increases the likelihood of a woman in labor to ask for an epidural. The epidural relaxes the muscles and numbs the lower pelvic area in such a way that slows down labor, which then leads to another dose of Pitucin, thus doubling the stress level to mother and child. At the same time, as the baby makes its way down the birth canal, it has higher propensity to get stuck in the sunny side up position now that the mother is relaxed by epidural and not able to shift about (being stuck on the bed) or push. The result? More intervention culminating in Cesarean birth. Well, that sounds like my birthing experience with Zoe!

There is still more reading, thinking and researching to do (see http://consensus.nih.gov/2010/vbac.htm).

But his much I know right now, I'll threaten to sue any nurse or doctor who tries to put Pitucin into my system or tries to break my water to speed up the process. (Yet another surprising thing the doctor said today. They would not induce, but the medical team at the hospital may want to use Pitucin if labor becomes stalled. But I thought they just said it increases my risk of rupture?) Also, I want to move around. I learned this much about the labor process, lying horizontal with the legs wide apart is the worst possible position for pushing. This means I can't have epidural. I'm going to try!