My Story
I am the creator the the dance work, BIRTH! Birth is my story. The story of the births of my five children and my subsequent process of. Being born again (at least 5 times). If you have a difficult time following the narrative of the dance story, don’t worry, is is a non-linear, sometimes stream of conscious story telling. Sometimes, I don’t even understand the chronology, and it is my story. If the narrative made sense to you, that is okay too. Your survivor brain, the cerebellum kicked in and made sure to make sense of things so you felt safe. Either way, whatever you experienced, you got it right. Though we don’t always understand them and cannot always explain them, our emotional responses to something are all valid and “true” for us.
I made this dance to help me make sense of and to process my own experience with birth trauma. In my healing, I heard and read literally hundreds of birth stories. These became my survival guide. I trust that my sharing my story pays it forward and is helping others navigate the terrain of their trauma as well.
The Beautiful and the Traumatizing
My first two babies were born via necessary cesarean section. My third baby was an unnecessary cesarean that I felt bullied into. This birthing experience resulted in extreme postpartum trauma, anxiety and depression. After my third birth, I sauté out healing modalities from talk therapy to support groups to meditation to crystals. These things all helped, but ultimately, I realized that I needed to tell my story through dance. So, I started to make a dance about my birthing experiences. While making this dance, I was pregnant with my fourth child. She was an unmedicated, hospital vaginal birth. My fifth child, and only son, was born at home in my bed on September 18, 2019. My husband caught him; I clamped his chord; My daughter cut it. IT was the most ordinary, extraordinary day of my life.
If you have never heard of the term VBAC, it stands for vaginal birth after cesarean and it is supported by the American College of Obstetrics and Gynecologists (ACOG) as a “safe and reasonable choice.” I want to be clear here, I am not anti cesarean. I am not telling you that vaginal birth is the only way to do it, or the right way to do it. I am not telling you that all cesareans are traumatic and that all vaginal births are beautiful and healing. I have had both traumatic and healing cesarean births. In fact, one of my most beautiful birthing experiences, was the birth of my second child, who was born via cesarean. I will tell you why it was so beautiful. The provider met me where I was; she was Mel she acknowledged my feelings; she gave me choices. I am not telling you how or where or when to birth your babies. That is not my place. You should get to choose what is best for your body, your baby and your family. I am letting you know that her are more safe options out here than we are often lead to believe and I am encouraging you to be as educated as you can and want to be about these options regardless of what your siblings, parents, in-laws, friends, coworkers, providers, the insurance company and everyone else think about said choices.
The Importance of Education
In the spirit of education, I want to share some information with you. The World Health Organization (WHO) recommends an average of cesarean rate around 10% to keep mortality rates for babies and women at it’s lowest. That means 10% of the time, cesareans are needed to keep us safe and I am so grateful for that intervention when its is needed. The problems is that our cesarean rate in America hovers around 30%, meaning 1 in 3 women have a cesarean. It is impossible for me to believe that if is medically necessary for one in three babies to be born via major abdominal surgery, and yet, those are the statistics. Of these women, many of walking away from their birth with false understandings about their bodies. Pregnant individuals find themselves in these very weird situations, where all of the sudden, they are not treated as the person with the body. For me at least, it felt like my body was everyone else’s proper and that what others thought they knew about my body got to make the choices rather than me making the choices about my body and my baby and my family with informed consent.
So, let’s talk a little bit about VBAC Facts. Have you ever heard the adage, “Once a cesarean, always a cesarean.”? If you have you are not alone. While it is a common belief, it is not necessarily valid from a scientific standpoint. Vaginal birth after 3 or more cesareans is a healthy option for some people; I am proof.
We don’t have much information on VBA3+C. Only a handful of studies have been published and the strength of their finding is limited because they only include a small number of women. Among the couple thousand women with three of more prior cesareans, only a fraction of them planned for vaginal birth after 2 cesareans (VBA2C) with VBA3+C making it impossible to break out the risk among higher VBAC’s.
We know there are risks of opting for a repeat cesarean. C-sections pose risks to mom and baby. These can be minor to life threatening and include excessive bleeding, blood clots, injury to organs, injury to baby, future risks with abnormal placentas (previa and acreta) and infection. As the number of cesareans increase, so doe the risks.
There are also risks associated with vaginal births after multiple caesareans. The biggest one discussed is uterine rupture. Again, we don’t have enough studies to know exactly how often UR occurs, the study we have included 241 people and you need a couple thousand people to report these rates accurately. So, with the limited scope study we have available, uterine rupture rate was 1.2%. This is a low number. There are other potential risks to VBA3+C births including oxygen deprivation to baby, or rates o excessive bleeding or hysterectomy in mothers. However, because of the limited data available, no one can really say what the risks of VBA3+C are. They are likely higher than VBA2C, but how much higher is unclear.
ACOG simply states that data regarding risks for women planning VBACs with more than two previous cesareans is limited. Many believe since ACOG only explicit mentions one or two prior cesareans, that means anything above that is outside guidelines.
However, we must remember that ACOG is not shy about making recommendations. If their goal was to risk out VBA3+C, they would have used plain language to make that intention clear. The did not do that. The most important think for parents to know is every decision surrounding your pregnancy and childbirth has risks and benefits. If you/your family is considering a VBA3+C there are many things to think about, including how many children you want to have.
Knowing what the research says is one thing to consider, but given that so few studies have been published on VBA3+C, we just don’t have good data. So, the most important thing for you to remember is that this is an area of unknown risk. Keep in mind that even those situations you still have to right and responsibility to make your own medical decisions.
This Decision is Yours
If you choose a VBA3+C, I can attest that it will be an uphill battle at times. It will be difficult to find a supportive provider. You will have a lot of unsupportive, stupid and unhelpful conversations with friends, family and co-workers, providers insurance companies and random people on the street all who feel it’s completely normal and acceptable for them to tell you what is best for you, your baby your family. You will be faced with a lot of fear language and a lot of random (and inaccurate) birth statistics and information.
I might add, frankly if you are not carrying the baby and did not contribute to physically making the baby, AND you are not part of the team chosen to be in the space, while the baby is born, you don’t get to share your opinion about how/when/where said baby is born.
The other thing to keep in mind is that most physicians and midwives do not attend VBA3+C For a variety of reasons that may not be about evidence, but rather policy or regulation. As a result, many families who want to labor after multiple cesareans, may have to travel long distances to find a supportive provider or choose an unattended birth. So, my final advice is this: Remember you are the boss of your birth. Ultimately, how you give birth is your choice and your right. In exercising that choice, you take on a measure of personal responsibility for your health care outcomes. Ask questions, find the best providers, birth in your safest place and research your options. AN empowered birth doesn’t only happen with vaginal births; an empowered birth is one where you were respected with true informed consent regarding all choices about your birth. Don’t settle for less and you’ll walk away feeling like a warrior regardless of how our baby comes into this world.
