I don’t know how to respond to this assertion. “Yeah, I’m seven months pregnant – I’m actually supposed to be this size,” doesn’t seem to be the reply they’re looking for. I realize they’re simply stating the obvious – and it’s not like they’re commenting on the 20 pounds I had gained during my freshman year of college or anything – but rather the undeniable fact that I’m carrying around a little person that will make his or her world debut pretty soon. And so my belly sticks out from my frame like a beacon, luring conversation in the wake of its wide berth.
With my belly as big as it is, drawing attention wherever it goes, those who know me best have also been requesting specifics about how this child will, ultimately, meet the greater realm existing beyond its currently sheltered belly abode. So I’ve been using a lot of abbreviations in my speech these days. VBAC and C-section, to be specific.
Elle was stubborn in the womb, insisting upon doing the opposite of what she was supposed to (not unlike her two-year-old self) by settling into an upright, toes-touching-nose pose worthy of yogic acclaim in the weeks leading up to her birth. Generally speaking, babies are no longer delivered vaginally in any other position but head-down, so Elle’s butt-down presentation won me a trip to the operating table for a planned cesarean birth. I was surprised (as was the attending surgeon) when she ended up coming out head-first anyway, after some covert late-game acrobatics… but that’s another story.
And so, the second time around, the big question posed to me is; “Will you have another cesarean?”
Decades ago, I may not have had an option in this matter. “Once a cesarean, always a cesarean,” as the saying went – referring to the medical policy that dictated women who had already had a cesarean would automatically have another one for the birth of their next child. The belief is that a C-section scar creates a weak uterine wall, putting a woman at risk of a ruptured uterus during a subsequent vaginal birth. Fortunately, the status quo has changed, giving women more of a choice in deciding their baby’s mode of delivery – via scheduled cesarean surgery or left to the more elusive whims of nature through a VBAC, or vaginal birth after cesarean.
While the “once a cesarean, always a cesarean” tenet no longer holds true in all cases, women who have had a cesarean are still drastically limited in their birth choices compared to women who haven’t.
According to a survey released by the International Cesarean Awareness Network, as of January 2009 a total of 821 hospitals had formally banned VBACs, compared to the 300 hospitals nationwide that had VBAC bans in 2004. This drastic increase in VBAC bans has been linked to the 1999 American College of Obstetricians and Gynecologists (ACOG) recommendation that effectively restricted VBACs to “institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”
It seems like a sound recommendation meant to protect the health and welfare of women and their babies. Yet what it has ultimately led to is a marked increase in C-sections, spurred by a decrease in VBAC coverage by insurance companies coupled with a fear of litigation within the nation’s hospitals.
Regionally, Grand Junction’s St. Mary’s Hospital is the only hospital in which a woman is invited to try for a VBAC. Yet a woman who wants to try for a VBAC at St. Mary’s still doesn’t have the green light: Her health insurance company must also give her the go-ahead.
My midwife explained to me that the new recommendations have meant that an OBGYN must be in the hospital during the entire labor of a woman trying for a VBAC. Normally, OBGYNs are on-call and not stationed in the hospital every hour of the day and night (although they are within minutes of attending to an emergency, my midwife explained). This seemingly minor staffing detail has complicated the VBAC process significantly, ultimately driving many hospitals and insurance companies to prohibit VBACs altogether.
Thus, VBAC rates have plummeted in recent years, from 28 percent in 1996 to a mere 8 percent in 2005. This trend is occurring despite evidence showing that between 60 and 82 percent of women who have the opportunity to try for a VBAC have successful vaginal births.
This decrease in VBACs relates directly to the overall increase in C-section rates around the world. Cesarean section is the most commonly performed medical procedure in the U.S. In 2007, for the 11th year in a row, the rate of C-sections increased – despite research that has shown that C-sections often carry as much risk to mother and child as vaginal births. You stand more than a 30 percent chance of having a cesarean today, whereas in 1970 your chances of delivering via C-section were just over 5 percent.
When I was pregnant with Elle, two of my three girlfriends who were also pregnant at the time wound up having cesareans. Now the three of us are pregnant for a second time, and we are each navigating the VBAC quandary.
Luckily, my hospital and my insurance carrier haven’t banned VBACs; so when asked about whether another cesarean is in my future, the belly and I answer; “Hopefully not.” There is no question that a C-section can, when performed for reasons beyond insurance industry politics or exaggerated litigation concerns, provide the best and safest means of bringing a baby into the world. But the high rate at which doctors are willing to resort to the scalpel are, in my opinion, grossly out of whack with what is truly best for moms and their babies. So, hopefully this giant belly will be able to avoid the operating table this time around.