Having a Vaginal birth after CS: What Gives?

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It took two days, and driving from one end of Lagos to another, in terrible traffic, from a government hospital to a private clinic, before my cousin gave birth to her first child. My cousin, Titilayo, was in serious pain for those two days, and it was really terrible for us to see her like that, and not be able to relieve her ache.

The worst part was her husband had travelled out of town, when her labour started, so my Mom, who is her aunt but acting as her mother, as my aunt is late, was there from the very beginning, and did all the hospital runs.
At first, the doctors said the baby was breech and that was why it was not coming, and then they said she had to wait. Perhaps the baby would turn itself the proper way and engage the birth canal. A day passed, but baby was still breech. And then, they had another theory; her birth canal was too tight. Not even when she was fully dilated would a baby be able to pass through, and that was when a doctor at the private clinic agreed to do an emergency C- section.

When the baby finally came out, Titilayo heaved a huge sigh of relief. She looked at the baby; a pretty handsome boy with a cute bow mouth, already rooting for something to suckle, and asked him if he was the one that had been disturbing her for the past two days. He made a cooing sound, as though in response.
Everyone in the hospital room burst into laughter at the baby’s sound, but everyone knew in their hearts that it was one of relief that both baby and mother were doing well, and we had no cause to share any bad news with the new father, who was yet to arrive from his trip.

After that first experience, both Titilayo and her husband were too scared to try for another baby. The doctors indeed confirmed that her birth canal was quite small, and that it would be really uncomfortable, if not impossible for a baby to pass through. She was told to prepare for a C-section, whenever they were ready to have another baby.
With that thought at the back of their minds, they did not bother trying, and for the next four years, they were just enjoying themselves, until she got pregnant again. I don’t know whether it was planned or not, but what I do know is that her husband was not so happy about the pregnancy. He was worried about her safety, the baby’s safety, and then the cost of another c-section, which is an almost given fact.

I’m not going to lie, during that pregnancy, my cousin became a prayer warrior, binding and casting every spirit of C-section, even though she had accepted that it was likely, some few years back. But all of a sudden, her tone changed. She did not want a C-section. All the while, she was praying and going for prayer meetings, her husband was saving for the cost of the surgery.

The long and short of the story is, when it was time to give birth, she had a C- section too, after putting herself through another two-days of labour, in her stubborn bid to have a vaginal birth. As soon as she was wheeled out of the theatre, her husband told her they were not having any more kids, and he began talking to the doctor about birth control methods. When Titilayo retorted that he should be the one having the birth control, he told her he was ready to do whatever was necessary, because after all, they were now blessed with a boy and a girl. Perfect combination, if you asked him. That was when she realized he was serious, and as soon as she healed, she had an IUCD inserted.

After five years, she removed that IUCD, and was waiting for a month, before inserting another…and then, it happened! She got pregnant again! It was a complete shock to her, and she discovered this when they wanted to insert another IUCD. As part of the screening, done before the procedure, a pregnancy test was conducted, and it came out positive. She told the doctor it was not possible, so they ordered some blood work. Lo and behold, my cousin was indeed pregnant. She had gotten pregnant within the month she was off her birth control. Talk about being a fertile chick.

Well, she knew, but how was she going to tell her husband, the man who had drawn his ears and warned her seriously that he did not want another baby?! In the end, she told him, and she very nearly got separated that night. Her husband left the house and was not seen for the next two weeks. He told her bluntly that he had no plans for three children, and added that she could do whatever she liked with the baby she was carrying, as he was having nothing to do with it.

She was a weeping mess, a very sad pregnant woman she was. Throughout that pregnancy, she was always crying, which is probably a mixture of pregnancy hormones and the deep seated sorrow brought by the unplanned pregnancy. This time around, she prayed like never before, that she would not have a C-section, because, honestly, how was she going to pay for it and her husband was still insisting that he would have nothing to do with the baby.

Then, it was time. Labour started, and she gave birth on the very day that her scan reports had predicted. Labour was shorter, and the best that could have happened for her was that she gave birth vaginally. The same birth canal that at least two doctors had said was unlikely to allow the passage of a child allowed her third baby pass through.

The theatre was already prepared for her when she gave birth, as she had resigned her fate to another surgery. But then the urge to push became unbearable. She did, and thank God there was a nurse nearby, who caught the baby in time. It was a miracle. She said the doctors were surprised that she actually gave birth vaginally, after the two C-sections she had had.

The truth is, nothing is impossible. You hear stories of how, if a woman has given birth via caesarean section twice, then that’s how she would birth all her kids. Or how you cannot have a vaginal birth, if you are birthing babies within 18 months of each other…but there are women, who have done exactly that, and the babies are fine.

However, medical experts have reasons to believe that having a vaginal birth after a c-section is a game of chance, with the odds in favour of having another C-section.

For example, a woman, who has already had an easy vaginal delivery and then had a c-section when her next baby was breech is much more likely to have a successful vaginal birth after c-section (VBAC), than one who had a c-section after being fully dilated and pushing for three hours with her first baby who was small and properly positioned.

That said, it’s impossible to predict with any certainty who will be able to have a vaginal delivery and who will end up with a repeat c-section. About 60 to 80 percent of women who attempt a VBAC deliver vaginally.

To know if you are a good candidate for vaginal birth after having had a c-section, the American College of Obstetricians and Gynecologists, says, you are a good candidate, if you meet some of these criteria, which are quite similar with the guidelines used by our doctors here. But the truth is, doctors generally have a guarded reaction towards, a vaginal birth after c-section; they would rather schedule another c-section, than allow the woman try, as it was in the case of my cousin. These criteria include:

• Your previous cesarean incision was a low-transverse uterine incision (which is horizontal) rather than a vertical incision in your upper uterus (known as a “classical” incision) or T-shaped, which would put you at higher risk for uterine rupture. (Note that the type of scar on your belly may not match the one on your uterus.)

• Your pelvis seems large enough to allow your baby to pass through safely. (While there’s no way to know this for sure, your practitioner can examine your pelvis and make an educated guess.)

• You’ve never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.

• You’ve never had a uterine rupture.

• You have no medical condition or obstetric problem (such as a placenta previa or a large fibroid) that would make a vaginal delivery risky.

• There’s a doctor on site who can monitor your labor and perform an emergency c-section if necessary.

• There’s an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.

The ball is now in your court, you can decide on what you want, with the help of your doctor.

Godspeed as you approach EDD!

 

 

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Photo credits:

1. http://www.ask.com/

2. http://elev8.hellobeautiful.com/

3. http://vbactexas.com/

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