With No Local VBAC Options, Leah Considers Unassisted Birth

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By Jill Arnold


The decision to give birth without a midwife or doctor in attendance is often a philosophical choice. Other times, it is borne from hitting too many dead ends while looking for access to VBAC (vaginal birth after cesarean). After hitting roadblock after roadblock, Leah is ready to have a friend help her give birth.

Born with De Morsier’s Syndrome or Septo-Optic Nerve dysplasia (SOD), Leah’s mother was told that her daughter would never surpass the intelligence level of a three-year-old. When Leah was a teenager, a doctor told her that she would probably never have a child.

Years later, at age 22, Leah was out to dinner with her husband, who asked if she was pregnant because she ate more than he did. She assured him that she wasn’t, but went to the doctor anyway. When Leah was informed that she was indeed pregnant, she began to shake because, as she says, “it was something [she] thought [she] could never have.”

Her pregnancy was “textbook normal” and the baby showed no signs of genetic abnormalities. On October 14, 2004, at 4 a.m., Leah’s water broke to their excitement. After just five hours of labor in the hospital, a doctor took her husband aside told him that he would not deliver her baby unless it was by c-section. According to Leah, they stopped her labor without her consent.

Her husband refused to sign the surgical consent form for her and told her that she was the one who needed to make the choice. He also told her, “The doctor said he’s scared shitless if this baby is delivered naturally.” Leah signed the consent form because they had stopped her labor and her water was already broken. Because of this, she feared for the health of her baby.

Leah was placed under general anesthesia. Wrote Leah:

They put me under so I was not awake for the birth of my first child. Many hours later, I wake up in the worst pain ever. I didn’t even have the strength to hold my beautiful baby girl. I told daddy he could hold the baby first. Later to find out, my husband made everyone wait to hold the baby so I could be the first one to do it. I knew that breastfeeding was best for me and baby. The head nurse came running when she found out that I was trying because the medicine I was on, they didn’t know the side effects that it may have on the baby. I was confused because I was taking it the whole pregnancy and she came out just fine. I told her this is what I’m going to do if you like it or not. I was living in Florida at the time.

Less than three months later, Leah was surprised to find out she was pregnant again. At six months pregnant, her milk supply had dropped to the point where she had to stop nursing and she prepared to be a mother of a one-year-old and a newborn.

On November 4, 2005 at 3 a.m., Leah’s water broke. She labored for two hours and decided not to go to the hospital two hours away where her OB-GYN worked, opting for the local hospital instead. She informed the hospital about her previous c-section from about a year ago and, to her surprise, the doctor offered to do a VBAC. Scared and not having been informed of the risks and benefits of VBAC, Leah refused the offer to VBAC.

Four years later, Leah went to a neurologist and asked him about her SOD and pregnancy. He told Leah, “If you can walk straight and don’t have any headaches, you could have had them naturally.”

Leah was angry. After that, Leah researched the disorder and pregnancy. She located a relevant study and contacted the researcher, who confirmed that vaginal birth is not contraindicated with her condition.

Now, five years after her last cesarean, Leah is pregnant again and was pleased to find in her research of VBAC that ACOG changed its guidelines, issuing a press release in July 2010 that stated, “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans.”

Leah has searched up and down the state of Maine (and part of New Hampshire) for a provider willing to attend a VBA2C (vaginal birth after two cesareans). The only two places that accept MaineCare and are willing to let her try a VBA2C are Maine Medical Center (MMC) in Portland and Blue Hill Women’s Healthcare in Blue Hill. Leah has been unable to find a home birth midwife who will accept MaineCare as a form of payment because, according to Leah, MaineCare does not reimburse for home birth.

Leah says she was refused by MMC because she lives too far for them to monitor her. She lives one hour away. Blue Hill is willing to take her but the drive would be two hours one way, which will prove too difficult in terms of arranging rides for prenatals. She doesn’t drive due to impaired vision and the four hours of driving in addition to waiting for appointments is too much for her friends, most of whom Leah says are low-income, too, and simply do not have the means, childcare or time to support her. The few family members in town whom she could ask will not support her, as they don’t see a problem with going to the local hospital and having a cesarean to get the baby out.

Leah has been receiving prenatal care from a local OB-GYN practice, although they refuse to attend a VBA2C. Leah says that if she doesn’t find local, accessible place where she can have a TOLAC (trial of labor after cesarean), she is “willing to do a UBAC.”

Leah’s struggles remind us that an unwanted unassisted birth and an unwanted repeat cesarean are two sides of the same coin. Approximately 30% of hospitals refuse to provide services to women who won’t submit to repeat cesarean surgery. Still more practitioners routinely discourage VBAC. No woman should be condemned for her birthing choices, but it is hypocritical to condemn women for going with what is, for many, their only option for a vaginal birth. 

 

Photo credit: MMC.org