We often think of the physical risks and benefits when talking about VBAC versus repeat cesarean section, but what about the toll on mental health? The stress of having a complication like placenta accreta is often not addressed and parents are left on their own trying to figure out how to cope with this serious diagnosis. So I was thrilled to come across a study finally addressing this issue and to include it in our monthly Grand Rounds for VBAC Facts Professional Members. Join me for this Grand Rounds excerpt where we review Tol 2019, a study looking at the connection between abnormally invasive placenta and post traumatic stress disorder.
In an attempt to validate parents, some perinatal professionals tell parents who have had a cesarean, “It’s still a birth.” And I get where they are coming from. Their desire to affirm to the parent that they still birthed a baby and that this is a happy moment. Here’s the rub and where unintended consequences come into play: As a cesarean parent, I did not feel like my cesarean was a birth and having someone tell me, “No really, it is,” would have felt really dismissive and invalidating despite the good intentions at play.
A VBAC study out of Canada reported, “Absolute rates of severe maternal morbidity and mortality were low but significantly higher after attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery.” After reading the abstract, and full text, I could quickly see how this study will be misinterpreted by many, so let me walk you through it.
A woman who had four cesareans, after planning VBACs and home births, recently contacted me. She didn’t know where she fit into the birth community. My heart went out to her because there have been periods in my life when I have felt isolated and alone. And it’s a crappy feeling. I replied to her, “A vaginal delivery is not required to participate in the birth community. There are many cesarean moms just like you who are seeking compassion, connection, and understanding. You could be a soft place for other women to land as they mourn (or celebrate!) their cesarean deliveries.”
“No one can force you to have a cesarean.” I see this all the time in message boards. That’s just not true. Let’s start with what is ethical and legal: Yes, no one can legally force you to have a cesarean. ACOG even says in their latest VBAC guidelines that “restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will.” So even if your facility has a VBAC ban, they still cannot force you to have surgery… legally or ethically. But then you have reality: It happens all the time, but it may look different than you expect.
I hear a lot, “What’s the big deal about cesareans? What difference does it really make if you have a cesarean?” Of course, if a cesarean is medically necessary, then the benefits outweigh the risks. But in the absence of a medical reason, the risks of cesareans must be carefully considered.