Leila Rose Petal

Deciding how Leila should be delivered has been a preoccupation for me since my last visit to the hospital. I’ve been preoccupied by it at the same time as I’ve been trying to avoid thinking about it. It’s a confusing way to be.

On the one hand I was pretty sure what my emotions and anxieties wanted me to do. But on the other hand I was very aware of all the arguments for the other option and could see their validity. Since I have another appointment at the hospital this Friday, I figured it was time to knuckle down, do the reading and make up my mind.

I did the reading and found myself back at the option that my emotions and anxieties wanted. I intend to tell the hospital on Friday that I will opt for a planned caesarien delivery this time. This means that Leila’s birthday will probably be a few days after Mark’.

A longwinded explanation of the pros and cons from my point of view follows, if you can be bothered reading it.

My first impulse was to opt for another caesarian delivery for the following reasons:
- A c section is what I know about. I’ve done it before and I know how it feels - although it could only feel better without the 10-12 hours of induced labour beforehand.
- After my head surgery, the operating theatre holds little fear for me.
- The logistics of organising time off work for Mark, people to help out and so on can only be easier with a hard date to work to (far too much time spent on project work, methinks).
- One of my greatest fears is repeating the experience of Finn’s birth. Yes, it all turned out beautifully, but that doesn’t mean that I want a repeat performance. And, if I opt for a VBAC (vaginal birth after caesarian), I would be raced off for a c section as soon as anything did not go according to plan, eg. failure to progress again, so there seemed a fair likelihood that it could be a repeat of last time. This point was probably the biggest one for me.
- At my last hospital visit the midwife told me that she thought (but would have to check to be sure) that women attempting VBAC were not given epidurals as it made it difficult to adequately monitor what was going on with the uterus. This would leave me with non-analgesic pain relief options (heat, massage, etc.), nitrous oxide (largely useless in my experience unless you want to feel kind of drunk) and pethidine (OK up to a point). I’m no hero when it comes to pain.

I couldn’t just go with that, though, because of the potential positives of VBAC:
- Going through labour reduces the baby’s chance of experiencing breathing difficulties post-birth.
- Women are believed to have an easier time bonding and establishing feeding, etc. with their babies after VBAC.
- There are also psychological benefits in ‘achieving vaginal birth’.
- I do believe that doing things the way nature intended should always be the default option and intervention should really only occur when that option is not tenable.

In my reading today (online of course) I read all the usual sources, which are generally positive about VBAC. This did nothing to allay my anxieties, in fact it made them worse. I was feeling quite ill about it all at one point. It didn’t help that few of them made much, if any, mention of the circumstances under which VBAC would be replaced with a c section. It all felt a bit one-sided. So I Googled.

I particularly wanted to find Australian references. The experience in the US and UK is interesting but, I feel, of limited relevance to me. I wanted to know what happened here. And I found this

The salient points from the article, to me, were:
- In the period 2000-2003 “58 percent of women were delivered by planned caesarian section instead of attempting vaginal birth after their previous caesarian (VBAC). And of the women who laboured after a previous caesarian … little more than half delivered vaginally.” So, if I opted for VBAC, I’d have about a 50/50 chance of succeeding. If those had been the odds of my head tumour being successfully removed it’s highly likely I’d have left it there.
- A study in Canada found that “the VBAC group were almost twice as likely to have a major adverse maternal outcome. … The worst outcome was said to be for women with a previous caesarian for ‘failure to progress’ and no previous vaginal delivery where about two thirds will have a vaginal delivery.” That’s the group I belong to.

It would be easy to acuse this article of bias and it does seem to be saying that maybe VBAC is being suggested more often than it’s a realistic option. It resonated with the non-emotional reason I was nervous about VBAC, being that there would be a fairly high likelihood that I would end up with another caesarian and, that being the case, why not just cut out the messing around and have a caesar?

So I found myself back at my first impulse with the added comfort of knowing that I have gone through the other options.