A Labor and Delivery Nurse’s Views on VBAC

By Dena Holstrom

July 12, 2010

By Dena Holstrom, RN

This guest post was written by Dena Holstrom, a labor and delivery nurse in Portland, OR. She is living in Spokane with her family this summer and has offered to contribute her own perspectives on issues surrounding pregnancy, birth and parenting. I look forward to more articles from her in the future!

Labor and delivery nurse Dena Holstrom and her family.

Nothing gets my ears perked up and my excitement stirred than chatting about birth. To be even more specific about what really gets my juices flowing are discussions surrounding VBAC births; vaginal birth after cesarean. It might make more sense to know that I am a labor and delivery nurse by trade and a mommy at heart. I get the pleasure of escorting new little souls into this life each and every shift and participate in someone’s best day and, unfortunately, sometimes their worst. I work at a Portland-area hospital and we see everything from the most natural, “normal,” labor and delivery patient to the most tragic, life-threatening situations; needless to say, it is a very special, very dynamic job and I am blessed to be a part of it.

I feel very qualified to speak to the topic of VBAC births, both professionally as well as personally. I am always eager to educate patients regarding VBAC deliveries because many providers fail to do so. Many patients don’t even know that it is possible to attempt a vaginal delivery after they have had a Cesarean section. I encourage all patients to be their own best advocates and discuss all of their options thoroughly with their providers. If a provider isn’t able to accommodate your needs and desires as a patient, I recommend finding one who does.

MY OWN VBAC STORY
I have been a part of many successful VBAC deliveries at work as well as experienced one myself, with my second child. My firstborn, my daughter Sloane, was not in an optimal position at time of delivery and after pushing for about 4 hours it was apparent that a Cesarean Section delivery was necessary. After an 18-24 hour labor, which is very normal for a first time mom, it was clear that she simply wasn’t going to be able to be delivered vaginally. I am very grateful for that C-section because I have a beautiful, healthy 2 ½ year old today.

Another factor in my decision to attempt a VBAC was knowing that labor is good for babies—contractions are good for babies! Its nature’s way of letting the baby know “it’s birth-day!”

While I was not traumatized by the C-section delivery or its recovery, I was left with this desire to experience a “regular” vaginal birth—a need to know what my body was capable of, as a woman. As a small side note, the thought of having an abdominal incision to recover from and a toddler who needed me, as well as a newborn, did not excite me at all. Being present at so many different types of births, I knew the operating rooms are a much more cold and sterile environment. I wanted the private, personal and quiet delivery room, where my husband and I could truly be present in the moment of the birth of our child.

Another factor in my decision to attempt a VBAC was knowing that labor is good for babies—contractions are good for babies! Its nature’s way of letting the baby know “it’s birth-day!” Research has shown increased surfactant levels in baby’s lungs of mothers who went through at least some labor, even if the delivery ultimately ended in a C-section. Surfactant is the fluid that helps baby’s lungs ventilate (breathe) easier after delivery.

If we had the choice, a VBAC is what we would choose. When we became pregnant with my son a year and a half later, I knew in my heart that I wanted to attempt to have a VBAC. I say attempt, because, as a labor and delivery nurse, I know the score…you don’t get to “choose” your birth, your body and your baby choose for you, meaning, how your body and your baby respond to labor ultimately chooses the path for your delivery. My care throughout both pregnancies were with the same CNM (Certified Nurse Midwife) at the hospital I work for, and after some thought and discussion with my husband, we made our desires known to our midwife. VBAC labor patients are carefully monitored throughout the labor and delivery process and therefore I felt very safe and confident in the hands of great nurses, a great midwife and seconds away from an operating room if we needed it. My labor and delivery was 2 hours TOTAL! 1 ½ hours of labor and 30 minutes of pushing and as he was delivering, I grabbed my son, pulled him onto my chest and experienced such an amazing feeling of euphoria.

I was privileged to experience all of what my body was capable of. Although I had great hopes for a successful VBAC delivery, I was very accepting of the possibility of another C-section as well. I would encourage all moms to embrace and accept the path your body and your baby choose for you, whether that be a vaginal delivery or a C-section delivery. A healthy baby, no matter what method of delivery, was my ultimate focus.

WHY AREN’T VBACS MORE COMMON?
There are many OBGYN providers out there that support VBAC deliveries. Unfortunately, those numbers are dwindling due to a couple of things. First and foremost is an increase, nation-wide, of lawsuits targeting OBGYNs in general. For this reason, OBGYN providers don’t want to take on any additional risk. VBAC deliveries are considered a high risk labor and delivery. When you cut the uterus for a C-section, the next labor can cause stress to that scar and cause the uterus to rupture. I would like to note, there is a less than 1% chance of a uterine rupture, and if attempted, a 70% chance of a successful VBAC delivery.

The other factor in OBGYN providers not offering VBACs, as one of their services, is the national standard, set by ACOG (American Congress of Obstetricians and Gynecologists), that states a provider who has a VBAC patient in labor must be in the hospital for the duration of the labor and delivery. Many OBGYN groups don’t want to be required to be “in house” for these patients. Most hospitals only require OBGYNs to be within a certain proximity of the hospital. For these two main reasons, we may actually see VBACs go away completely.

WHY IT MATTERS
My heart breaks at the thought of never having the opportunity to choose to listen to that deep desire inside me. And equally as painful is the thought of never sharing that moment with my husband and my child—my definition, of complete connectedness.

Attempting a VBAC delivery was the right decision for me and I encourage all moms to listen to their inner voice, educate themselves about their options and seek out providers that are in support of your desires.

I would like to also acknowledge that my successful VBAC delivery had its challenges, painful moments and its own recovery period. Labor and delivery, no matter what the method, is not for the faint of heart and no “brownie points” will be awarded at the end. I know many women, personally as well as professionally, that choose to have a scheduled, repeat Cesarean section. Many of them don’t have a desire to experience a vaginal birth, many have fears about vaginal deliveries related to their first birth experience and many are unaware of the opportunity to attempt a VBAC delivery.

Attempting a VBAC delivery was the right decision for me and I encourage all moms to listen to their inner voice, educate themselves about their options and seek out providers that are in support of your desires. Above all, there are no failures when it comes to birthing babies, only two very important lessons in parenthood: Simply the biggest love you have ever known and that you are not in charge anymore

Dena Holstrom has been a nurse for 10 years and is a mom to two beautiful kids, Sloane and Axel. She enjoys offering her own childbirth workshops in the Portland area, www.babyloveworkshop.com.

Share and Enjoy: These icons link to social bookmarking sites where readers can share and discover new web pages.