VBAC & VBA2C

Zoe's Delivery by Mwesigwa

VBAC (Vaginal Birth After Cesarean), or lack of it, is one of the major reasons for America's steadily (or should I say, alarmingly) rising Cesarean rate - currently a whopping 32.8% of all Amercan births end with an incision. Recently Richard Waldman MD, the president of the powerhouse medical organization, the American College of Obstetricians and Gynecologists, made a powerful statement concerning his colleagues quick jump to surgery. This year, at their annual conference he said:

"In 2008 the cesarean delivery rate reached another record high—32.8% of all births. There is a community not far from my home in which 45% of the newborns are delivered via an abdominal incision. [...] Liability dampens our spirits but unfortunately, it is also starting to define our specialty. [...] Let us recommit to do everything in our power to perform surgery only when necessary. Let us recommit to induce only when indicated and let us vow to never electively induce or perform an elective cesarean prior to 39 weeks. Any time we are tempted to take the safe path but not the righteous path, we should all say, “not on my shift."

It is a refreshing statement, one I hope holds up to the testing grounds of hectic and busy maternity wards. In our modern world it often seems that Cesarean is the only "choice" women have in the hospital to keep them and their babies safe. But our bodies have not changed since 1975 when the US Cesarean rate was 10.4%, obstetric training and practice has. Midwives have always been on the side of women and their bodies, learning and studying normal physiological birth in order to safely deliver women, and even now are often the only option for women who desire a chance at vaginal birth.

VBA2C refers to Vaginal Birth After 2 Cesareans. It is an unfortunate fact of life that many women now are in the situation of having had more than one Cesarean, but still long for a vaginal birth with a subsequent pregnancy. ACOG has in its guidelines on VBAC, allowed for a trial of labor with 2 or more Cesareans if a woman has had a vaginal birth before. Now a recent study has shown that even if a woman has not delivered vaginally before, she should still be allowed a trial of labor, even if she's had 2 prior surgical deliveries. In their findings VBAC in these cases, was successful 71.1% of the time. Uterine rupture, of course the sole reason for not allowing for VBACs, increased to 1.36%, which is roughly double what it would be in a woman who has had one prior surgery. But the tone of the researchers was encouraging and prompted practitioners to also caution their patients about the risks of a third repeat cesarean, in the light of these findings. Now that's informed consent.

This is great news for many women. Check out the video below to truly see the joy a successful VBAC can bring to a mother's face. If you want more information on VBACs in general check out this enlightening Cesarean fact sheet.

Birth Story - Baby Abdurahman

By Faraz_Ilu

This moving birth story is from a mother, Umm Abdullah, who had a C-section for her first, and a VBAC (Vaginal Birth After Cesarean) in a birth center for her second. Umm Abdullah was incredibly educated and persistent in her decision making around her VBAC birth and it was thrill to be able to aid her on this healing journey.It was a joyous day for all when little Abdurahman arrived! She was blessed to have the resources available to her to achieve the VBAC, unfortunately, many in this country are not so lucky and are forced to have repeat Cesarean surgeries. Recently, though the tides have been changing and there has been a lot of attention given to allowing more VBACs in America. Newsweek recently documented the changing attitudes about VBACs and the National Institute for Health has just convened a conference all about VBACs. You can read the results of that conference here and a NYT summary here. And now, the birth story....

Ar-Rahman's Gift

by Umm Abdullah

My second son, Abdurahman, was a gift from Ar-Rahman, as was his birth.

My first son, Abdullah, was born via c-section. Despite an un-medicated labor in which I even refused the IV, and an hour and a half of pushing, Allah willed that he come into this world with the help of surgical intervention. Alhamdulillah, he was a healthy and beautiful baby with a purple, cone-shaped head, and he latched-on to the breast vigorously despite the one hour interlude from the time of his birth until I could hold him in my arms. I brought him home with a sense of gratefulness to Allah for blessing me with His gift, yet I could not shake the sense of dissapointment that I had in not being able to birth naturally. I started to research VBAC (vaginal birth after cesarean) in those early post-partum days.

Almost exactly two years later my husband and I were blessed with another pregnancy. I knew that this time I would do things differently. I researched and searched, and realized that the best way to give myself a chance at a successful VBAC was to avoid the hospital. In the hospital, interventions are used routinely, and often times not out of real medical necessity. These unnecessary interventions interfere with the natural birth process and lead to unnatural results. Plus many women who gave birth in non-hospital settings, such as birth centers and at home, wrote of such amazing, positive birth experiences. I contacted a midwife named Shannon, a Muslima alhamdulillah, who works in a birth center, and my husband and I decided to meet her and tour the center. From the moment I met her I knew that I wanted her to be the one to help me deliver my baby, biithnillah. She is my sister in Islam and I was blessed to have her there for me from the start of my pregnancy, alhamdulillah.

One morning three weeks before my due date I was laying in bed reading stories of natural births when I felt a lot of pressure and more 'contractions' than the day before. I called Shannon and the rest of the day I noticed more and more pressure and contractions. Sure enough, by evening time I began contracting rhythmically and they were becoming more painful. I mustered up the energy to do a light cleaning of the house, packed my bag, and my husband and I drove to my in-law's house. We stayed there all night. My contractions were getting more intense but I took my midwife's advice to lay down on my side and try to get as much sleep as I could. This is the best piece of advice I can give to a woman in early labor: Don't get excited, sleep as much as you can! Towards fajr time it was very difficult for me to get any rest but I let my husband sleep some more because I knew he would need the rest. I took a shower which was very soothing. Some family members came in the morning and took my older son out and my husband and I headed to the birth center. We arrived there around 11 am and upon checking me Shannon said I was already almost eight centimeters dilated, Allahu Akbar - that was wonderful news!

We settled into a birthing suite (I picked the blue one). My doula arrived at the same time we did, and for the next few hours my husband and my doula did an amazing job of helping me through my contractions with massage, moral and physical support, and lots of liquids and yummy snacks. Every contraction was getting stronger and I was using breath awareness along with visualization to help me through. I thought about Maryam (alayha salaam) and how she did it all alone. Allah, aza wa jel, helped her and I knew He would help me too. He, subhanahu wa t'ala, would not give me more than I can bear (that's a promise from Him!). It was so wonderful to eat and drink as I pleased (which you are not allowed to do in the hospital), to try different positions without being strapped to beeping machines or with something poking you in the arm, and to have complete privacy. The only man that was there was my husband and it was a very intimate and comfortable environment, a requirement for natural labor. Standing up and holding on to a birth ball on the bed was my position of choice. Every time I would squat another contraction would come and this position allowed me to have some control over the contractions. My midwives were checking the baby's heart rate intermittently with a stethoscope and testing my urine hourly, and I felt that was in such good hands, alhamdulillah.

My contractions were becoming extremely intense and I knew I was in the transition phase. The intensity of the contractions made me feel overwhelmed, and the midwives recommended I try the birthing tub for relaxation. As the water to fill the tub was flowing my water burst and I knew the baby was coming. I called out to Shannon and she placed a birthing stool under me. I held on to the sides of the stool and began to push. Nervously I asked whether I should be pushing even when there is no contraction and Shannon told me to do whatever felt right for me. That was a sort of mantra during the labor and it was such a wonderful and intuitive piece of advice, advice that I would never have gotten in the hospital. I pushed as I felt was right and before long the baby's head was almost out. In fact, I only pushed for ten minutes before he was born. The last push was intense but when Abdurahman came out and was given to me I felt sheer elation (along with relief). His little body felt so sweet against my chest.

Not once during my labor or delivery did I think about another cesarean. Allah, ta'ala, took that concept out of my mind completely, alhamdulillah. I was surrounded by caring, warm people whom I knew and who sincerely wanted the best for me and my baby. Undoubtedly it was hard work, but in the end I was blessed with an experience that I would never forget or want to change. Subhan'Allah, what a blessing from Ar-Rahman.