As they wait for their bundle of joy to arrive, soon-to-be mothers spend countless hours dreaming of names, researching to find the perfect car seat, and trying to learn all the ins and outs of bottle and breastfeeding. Some search for a doctor while others seek out a midwife. But especially for first-time mamas, the labor and delivery part of having a child can be an unknown and even unnerving thing. As each hopes for her own perfect birth story, many have a plan in place for what they imagine labor and delivery should look like, but the reality is that things do not always go as planned.
Cesarean sections, often referred to as C-sections, are always a possibility, and though we are extremely fortunate to have access to the often lifesaving surgery, rates of C-section have risen dramatically in recent decades. In fact, the CDC’s National Center for Health Statistics reports that nearly one in three babies born in the United States are delivered by cesarean section.
In the past, having a C-section meant that all future children would likely be delivered via surgery. However, many women who face the reality of a C-section today often seek out options to avoid having the surgery for a subsequent delivery. Those who do not wish to go through surgery again often come across the term VBAC, which stands for vaginal birth after cesarean, and hope that this might be an option they can pursue.
According to the American Pregnancy Association, to be considered for VBAC, some initial criteria must be met. The mother’s history should include no more than two cesarean deliveries and no additional uterine scars, anomalies, or previous ruptures. Healthcare providers should be able to monitor labor and the birth location should have personnel available in case a cesarean is needed. The American College of Obstetricians and Gynecologists (ACOG) suggests that factors likely to increase the odds for completing a VBAC include a healthy pregnancy weight, going into labor at or near term, labor that is not induced, and no current pregnancy complications.
However, attempting VBAC is not without its own unique risks. According to ACOG, when attempting a vaginal delivery, though the risk is fairly low from 0.2 to 1.5 percent, women who have formerly undergone a cesarean section have a higher possibility of uterine rupture, which, though rare, is a serious complication that can result in severe bleeding and even the death of the baby. Many providers choose not to offer VBACs so as to forgo the potentially fatal risk altogether. Furthermore, due to a lack of staff or resources to handle emergency C-sections, many hospitals, including those in the Valley, have placed regulations and restrictions that have caused doctors to discontinue the practice.
In the last few years, Dr. Daniel Lee of New Life Ob-Gyn Associates was one of the few providers who performed VBACs in the Valley. He completed many successful deliveries through VBAC with no uterine ruptures occurring. However, due to the recent changes in hospital policy, he has determined that it is no longer feasible to provide patients with that option. These policies require that doctors who are caring for patients who are attempting VBAC be “readily available” during the entirety of the labor process, which can take hours upon hours in even the smoothest of cases. The extended time spent at the hospital during the labor process is often not a possibility for doctors who see many other patients and often have family lives outside of work.
Though he no longer provides the option for patients to attempt a vaginal birth after having gone through a Cesarean section, Lee leads the way in in his field, staying current with up-to date research so that he can offer the best possible birth options for parents. Among these options, Lee performs what is referred to as a family-centered C-section, also known as a gentle C-section.
One of his patients, Norma Hess, shared her experience. As a birth photographer, Hess has had the opportunity to witness a variety of birth scenarios, but as a mother of five children, she has also been through her own unique birth experiences. During her first pregnancy, Hess’ labor was induced, but after little progression in 26 hours, her doctor at the time decided to perform her first C-section. This was not what she had hoped for, and due to her experience, she and her husband waited for about three years before having their second child. This time, Hess learned of the possibility of VBAC, and found a new doctor who claimed to be supportive. Unfortunately though, even with two weeks to go until full gestation, at 38 weeks her doctor “flipped the switch.” He said that her baby was very high and recommended a repeat C-section to be performed at 39 weeks. Feeling a sense of defeat, Hess complied and had her second surgery.
After this second birth, Hess and her husband began to focus on adoption, and during the process became pregnant with their third child. This time, she knew the drill and interviewed many doctors even as far as Corpus Christi and San Antonio. The general response from doctors in the RGV was that if she reached 39 weeks without going into labor, they would perform her third C-section. Though she was able to find a doctor in Corpus Christi who agreed to perform the VBAC, ultimately, the distance weighed heavily on her mind and Norma decided that she should find someone in closer proximity. She began working with a midwife, Ana Ochoa of Beautiful Birth Maternity, and was thrilled to have a completely different experience for her third pregnancy.
“It was a completely different level of care,” Hess said of working with a midwife. “I really got to know her.” Hess felt comfortable asking questions and was hopeful that she would be able to complete the VBAC as planned. As 40 weeks of gestation rolled around, then 41, and then 42, due to state laws, the midwife was legally unable to keep Norma on as a patient. With her back-up doctor having moved out of the area, the pregnant mother of two was without a midwife, without a doctor, and 42 weeks and one day pregnant. Hess went into labor that night. After ending up at the hospital with no doctor, even though she was already in labor, Norma was not given the opportunity to attempt the VBAC and was quickly ushered in to undergo her third C-section.
For her fourth time around, Norma knew that it would be impossible to find someone to perform a VBAC, and that is where Lee came in. With a focus on skin-to-skin contact for the mother and baby, as well as keeping the baby nearby for the entirety of the process rather than being taken away from the mother for hours after the surgery, Lee’s emphasis on family proved to provide a completely different atmosphere for the Hess family. Lee has shown commitment to providing the best options for patients, even using clear drapes for surgery so that the mother can be more involved in the birth. Hess praised Lee and was thankful for her experience.
“Although I never achieved the VBAC that I wanted, it was a very healing experience for me,” she said.
Currently, options in the Rio Grande Valley for VBACs are limited to midwives who deliver at a birthing center or patient’s home, a very few Ob-Gyns, and the Obstetrics and Gynecology Residency Program at Doctors Hospital at Renaissance. This may change if hospitals start laborist programs, as is common in many large cities. These programs have board-certified Ob-Gyns and certified nurse midwives who stay on the labor and delivery unit 24/7 to manage patients in labor.