“This is the lady who had the natural birth after a c-section!” beamed one midwife to the other as they passed each other at my hospital room door. “Wow…” said the second, adopting a tone of habitual, absent-minded kindness as she bustled in and took a look at my chart. “How are you feeling?” she said before pausing. “Hang on. You had a natural birth, AFTER a c-section?” “Well, yes obviously not with the same baby,” I laughed. “Oh yeah, I was thinking” said the midwife, paying attention now.
“I had an emergency c-section nineteen months ago,” I said “and I’ve just had a VBAC (Vaginal Birth After a Caesarean)”. “Ah, I see. Well, well done you!” she smiled. Later, she repeated the news to another nurse in a similarly amazed voice: “This is the girl who had a natural birth after a c-section.” “Wow.” I was starting to feel like a bit of a celebrity, someone who had achieved something rare and unusual. My first baby was born in 2006 and my second in 2007, but I’ve only recently seen numbers that demonstrate just how rare and unusual my experience was, and continues to be. This is not good news for mothers.
Figures released at the end of March by the HSE to AIMS Ireland (Association for Improvements in the Maternity Services) for birth statistics in Irish maternity hospitals in 2012 showed that VBAC rates ranged from 0% in Castlebar, Portlaoise, Letterkenny and Mullingar to 33.86% at the National Maternity Hospital in Holles Street. The Coombe in Dublin had the next best rate at 22.88%. The only hospital outside Dublin approaching this was Waterford Regional at 20.63%. South Tipperary General Hospital in Clonmel had a rate of 17.07%. The rest ranged from St Lukes in Kilkenny at 0.93% to around 10%.
I had both births at Mount Carmel, a private maternity hospital which closed at the end of January and was not included in the HSE figures. Birth statistics for Mount Carmel for 2009 show VBAC rates at 1.5%. No wonder the midwives were surprised.
Such wide variance is not to do with numbers of suitable candidates. It is about hospital policy and in-house expertise. It is also to do with fear. Even the medical language around VBAC, which speaks of “attempting a trial of labour”, implies the outcome is more likely to be ‘tried and failed’ than ‘went for it and succeeded’. We need to change that.
VBAC is not without risk. There are criteria to determine this, including number of previous c-sections, uterine scar type and foetal position – but no birth is without risk. Birth is an unpredictable journey for baby and mother.
That infamous phrase “Too Posh To Push” remains a strong contender for headline of the century, but it has also done a massive disservice to women for whom a caesarean is the safest option. C-section rates are worryingly high in the developed world, but not all of these are elective or unnecessary medical interventions.
Having experienced both, I would choose a natural birth any day. Compare: no drugs (I laboured using yoga techniques), immediate post-birth skin to skin contact, and being up, showered and beaming at the midwives, baby in arms, a few hours later; to abdominal stitching both in and out, an hour in recovery without your baby, a catheter, drugs and weeks of pain management and healing. There’s no comparison. Both births resulted in a healthy baby, but the natural option resulted in a mentally and physically healthier post-birth mother.
Positive anecdotes and peer support may be the fastest way to increase VBAC rates. We need to share more stories of success in order to show more women it’s possible. Women need to speak up and insist that doctors work with them to investigate all their options. If you don’t ask you won’t get. VBAC shouldn’t be a novelty in Irish hospitals. It should be a standard option for women with no complications, pregnant subsequent to a caesarean section.
A version of this article was first published in The Sunday Times Comment section on 27 April 2014.