VBAC At Home: Courageous Or Crazy?
According to an article written by CNN Senior Medical Correspondent Elizabeth Cohen, Aneka was told that, because she had three previous C-sections, she could not attempt a VBAC (vaginal birth after Caesarean) of her fourth child. Hospital after hospital, doctor after doctor, denied her the right to try. But after watching Ricki Lakeís 2008 documentary The Business of Being Born, Aneka decided she didnít want a fourth C-section. With no local hospital willing to support her autonomous decision, Aneka decided to take matters into her own hands. She found a midwife willing to deliver her baby at home Ė and after 20 hours of labor, she delivered her fourth child.
Anekaís decision to advocate for her own health care wishes Ė potentially at the expense of her babyís safety ≠Ė have since polarized online communities, splintering people into those who advocate for natural birth and those who value the guidelines of the traditional medical community. Some natural birth advocates celebrate Anekaís courageous decision and lift her up as an iconic home birth revolutionary. Others chastise her for defying the advice of doctors and putting herself and her baby at risk of potentially dying as the result of a ruptured uterus or other VBAC-related complication.
What Do I Think?
Iím an OB/GYN, and most of my readers know that I speak out when I have an opinion, so yes Ė I do have an opinion, but itís not a polarized one. Honestly, I can see both sides of the debate. Sure, this story sounds uplifting and makes for great headlines: “EMPOWERED WOMAN DEFIES AUTHORITY AND WINDS UP WITH HEALTHY BABY AND NO SURGICAL INCISION.”
Sure, Iíll bite. You go girl! More power to ya! Down with the man. And all that jazz.
But while allís well that endís well, this story would have been cast in a very different light had Aneka or her baby died in childbirth, or had her baby wound up with cerebral palsy as the result of childbirth complications stemming from her decision to have a high risk birth at home. The risk of such an outcome, while rare, is real. And yes, Iíve seen it happen. You donít ever forget those kinds of things.
Letís consider both sides.
In Support of Aneka & Her Decision
Aneka did her homework, understood the risks, and made a conscious choice to take her body into her own hands. She refused to be bullied into the medicalization of her birth and stood up for what she desired, in spite of the lack of support she found from her local doctors and hospitals. That she was willing to overcome her fears, be authentic about who she is and what she wants, and stand for what she believed in the face of intense pressure to conform makes me want to jump up and hug Aneka. If only more of us were willing to do the same, I believe the world would be a better place.
In Support of The Doctors & Hospitals
Those of us who have witnessed what happens when a woman with a prior C-section ruptures her uterus know how quickly things go south. One minute, everythingís peachy. The next minute, the babyís heartbeat drops off and you may have a mere 7-10 minutes to get that baby out lickety-split before the baby winds up disabled or dead and the mother ends up hemorrhaging to death.
Whatís the chance that a uterus will rupture? 0.5-0.9 percent if youíve only had one C-section before and 1-3.7 percent if youíve had two or more. Which means that youíve got a good chance of avoiding such a disastrous outcome. But what if youíre that 1 percent?
My Two Cents: It’s All About Informed Consent
Ultimately, itís all about choice. I believe that Aneka has the right to understand the risks, to make a thoughtful, well-informed decision, to weigh the pros and cons, and ultimately, to buck authority if thatís what she chooses to do. She doesnít need anybody judging her, bullying her, or manipulating her into doing something with her body that she chooses not to do.
When I worked at a public health clinic delivering babies where 99 percent of my patients were Somali immigrants, I often recommended C-section or other medical interventions to women who chose not to heed my advice. While some of my colleagues would whip off their gloves and refuse to care for these women Ė dismissing them as ďuneducated, immoral heathens with no appreciation for the value of lifeĒ ≠Ė I respected these women as equal partners in a health care relationship.† Coming from a vastly different culture, many of them held very different beliefs about their health care, and many had a profound faith in Allah that rendered them capable of completely surrendering to what would inevitably happen, with or without whatever medical intervention I was offering.
If these women chose not to have a C-section Ė even one that might save their babyís life Ė I bowed to their wishes and helped shepherd their child into the world in a way that melded with their individual belief systems. To inflict surgery upon another individual against their will is assault, plain and simple.
Most of these cases wound up with happy endings. Some did not. But ultimately, my job was merely to educate, to offer guidance, to make recommendations, and then to respect the wishes of my patients. Period.
Be An Empowered Patient
The moral of this story is that you do have a choice.† You may think that the medical complex rules your health care, but they donít. YOU rule your health care. You get to choose. Itís your life. Itís your body. Do your homework. Ask lots of questions. Read Elizabeth Cohenís fabulous book The Empowered Patient. Demand respect. Understand the risks. Think things through to their worst possible outcome. Find a new doctor or hospital if you need to. Then insist upon having your autonomy upheld. Itís all about informed consent. Be an informed consumer, make empowered choices, and never let anybody walk all over you and your body.
You are in charge. Donít let anyone ever convince you youíre not.
What do you think? Was Anekaís behavior heroic? Reckless? What are your thoughts on natural birth? Vaginal birth after Cesarean? Do you make informed choices about your own health care? Would you ever stand up to authority to demand that your wishes and your body be respected? Do tellÖ
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