Saturday, December 21, 2013

VBAC Journal - Part 1

When I gave birth to my 2nd child via caesarian section, I didn’t like how it turned out. Why? Well, aside from the fact that CS delivery was more expensive than normal delivery, it gave me a lot of physical and emotional trauma. Below are the disadvantages that I’ve experienced.

1. Yes it was not painful during delivery, but it was one heck of a pain post-delivery. And the pain lasted for 1 and a half years before it was completely gone. 
2. And because it took a while for the pain to be completely gone, I was not able to exercise to get my body back in shape. I gained more weight due to lack of exercise and only had the determination to shed them off 5 years after I gave birth.
3. My breast milk did not come out until a week after delivery, probably because I didn’t really experience contractions that much. 
4. I’ve read somewhere that CS born children have lower levels of good bacteria in their gut, something that they would have naturally acquired if they passed through the birth canal. Because of this, their immune system is relatively weaker compared to normally delivered children. I’ve noticed that this was particularly true about my Isabella because we never failed to bring her to a hospital at least once every year. 

Now that I’m on my 3rd child, I was determined to give birth via normal delivery, whatever it takes! I researched and learned about this medical term called VBAC or Vaginal Birth After Caesarian. As the name suggests, it means being able to deliver vaginally after 1 or more caesarian deliveries. Not everyone is a candidate for VBAC, by the way. It’s a good thing I am because:

1. I have previously given birth via NSD or Normal Spontaneous Delivery to our late son prior to Isabella.
2. My Caesarian delivery with Isabella was done with a low traverse incision (bikini cut), which lowers my chances of having a uterine rupture.
3. The period between my CS delivery and this delivery is 6 years. 
4. The cause for my previous CS was placenta previa and if that cause is no longer an issue now, I would be allowed to have a TOLAC or Trial of Labor after Caesarian.
5. My baby is in cephalic position. – Although, you must not give up if on your dreams of having a Normal delivery, whether you’ve had previous CS or not, because there are a lot of ways that you could do to direct your baby to the right position. 
6. I’m not having twins.
7. I don’t have other issues that may threaten me or my baby such as diabetes, eclampsia, etc.

So, the only other thing essential to my successful VBAC is an OB-Gyne who supports it. IMHO, medical practitioners in the Philippines nowadays are more concerned about their revenue than their patients’ welfare. For one, a lot of mothers in my generation delivered via CS and when I asked them why, the reasons seemed manageable for NSD. Two, delaying post-delivery procedures is beneficial for the baby because delayed cord clamping increases early hemoglobin concentrations and iron stores in infant and delayed cleansing of the baby gives vernix caseosa longer time to moisturize the baby and help protect her against a wide variety of infections. However, delaying these procedures would also mean more time for the medical team to attend to one “customer”. Three, most mothers who previously delivered via CS are encouraged to have CS on their succeeding births.

I have experienced all of these, which is why I don’t have THE ONE OB yet! I’ve had prenatal check-ups from several different OBs. The first one, whom I really liked, said that as long as my baby is not oversized and I have all the qualifications for VBAC until I give birth, we’re gonna try it. However, one thing that worried me at the time was when she said that as soon as my cervix is dilated, even just 1cm, I have to be confined at a hospital for continuous fetal heart monitoring until I give birth. She said that was the difference between VBAC and a regular NSD. Based on my research on successful VBACs, mothers should be allowed to move around to naturally induce labor and a fetal heart monitor would not give her much freedom to do that. Another thing is that, being confined at the hospital from 1cm to 10cm for who knows how long would be very expensive! Unfortunately (or fortunately) this doctor got pregnant the same time that I did and had to go on LOA on her 3rd trimester. 

When the 2nd OB said I sought help from said: “Nako, kailangan mas malit ung baby mo ngayon sa una mong baby para mag trial of labor. Otherwise, bakit pa natin pahihirapan ang mga sarili natin?” (“Your new baby should weigh lesser than your previous baby to have a trial of labor. Otherwise, why would we make it difficult for both of us?”), I knew that I didn’t want to deliver the baby with her. Having a bigger baby does not disqualify a mother from having a TOLAC and I can’t imagine how the next baby can be even smaller than Isabella just weighed 6.5 kg when she was born.  I am more than willing to do hard work just to deliver the baby via NSD and if she’s not, we can’t be partners. 

I had prenatal check-up with a 3rd OB and she gave me promising information. Because she was my husband’s mother’s friend’s friend, she offered that she would treat my case as a house case, which meant that she would only be a consultant when I give birth but the ones who will facilitate my delivery would be the residents of this certain hospital. This also meant, I would only have to pay hospital fees and not professional fees. She said the residents would love if I have a successful VBAC because it would be a great case for them, making them really encouraging and patient. 

I’m kinda skeptical about having to be handled by residents, not to mention the rates at that hospital aren’t really that affordable. It so happened that one day, hubby and I stumbled upon a lying-in clinic on our way home. The rates are so affordable even though OBs are the ones who facilitate all of their deliveries. Emergency CS can’t be done on a lying-in clinic though, which meant you have to make accept the nearest hospital that the emergency team will bring you where the OB is affiliated with.

I haven’t set-up an appointment with an OB at that lying-in clinic so I haven’t decided whether to go with them or with my 3rd OBs suggestion. Pray for me!

your every woman,


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