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Posted by Sarah Stogryn on

Caregiver to full-term mom hoping for a VBAC:  "Yes of course I support your decision to have a TOLAC (trial of labour after cesarean).  But you need to understand that “our local hospital” doesn’t keep an OR (operating room) staffed and ready 24/7.  The greatest danger in a TOLAC is uterine rupture (UR).  That could be catastrophic because the OR isn’t always ready to save you and your baby.  You’ll need to sign this waiver which says you understand that by choosing a TOLAC you and your baby could die, and that you don’t hold me or the hospital liable if that happens."

Friends and clients have recounted conversations just like this to me, along with many variations on the same theme, more times than I care to count.  And this is from the caregivers who are considered supportive of a TOLAC!  
What the caregiver said is true, but it isn’t the whole truth.  And in my opinion, giving only information about the risks associated with a TOLAC (also known as an attempted VBAC - vaginal birth after cesarean), is like showing someone the toenail of an elephant and not telling them its only a toenail, so that they are led to believe the toenail IS the whole elephant, rather just one small piece of a much bigger picture.

There are of course risks in a TOLAC/attempted VBAC.  There are risks for your average woman giving birth.  And there are risks associated with caesarean birth too.  It isn't really about which path has the least or lowest risks, but rather, which set of risks you the birthing woman are most comfortable with.  Surgeons have their preferences based on their own experiences and biases.  Policy-makers too have preferences based on their experiences and biases.  And there is nothing wrong with having preferences! However, just because 'they' prefer a particular path, doesn't mean you automatically should too.  You & your family are the ones who have to live with the outcomes of your birthing choices.  You have your own experiences and biases and they count at least as much as those of the medical and policy-making communities.  Your own history, beliefs, cultural, social, religious, economic, and familial factors will all come into play, in addition to what the research says, as you make a decision about how to best proceed through a pregnancy and birth after a cesarean.  And I urge you not to accept second-hand research.  Just because your caregiver, doula, best friend, newschannel, facebook feed, mommy group, or twitter says it, doesn't make it true.  Go to the source.  Read, ponder, meditate -- take full ownership of your birthing journey.    
Now if I (a doula) am telling you not to take my word on VBAC vs ERCS research, what do I (a doula) actually doto support women who are pregnant or planning a pregnancy after cesarean? A doula can help you see the "whole elephant"; walk with you through the decision-making process;  and support you as you strive for your best birth. A doula can help you figure out how to talk with your loved ones and caregivers about your decisions, and provide a continuous reassuring presence throughout your pregnancy, birth, and early postpartum experience - even if (perhaps especially when!) it doesn't all unfold in the exact way you envisioned it.

Here are some great resources to get you started on the post-cesarean birthing journey:

Childbirth Connection 

Giving Birth With Confidence 

VBAC Facts



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