which way is out?

For most women, the answer to this question is the same for each child they have. The delivery of a first baby is considered a ‘trial of labor’ in this way and once you prove that your vagina (excuse the frankness) is a viable exit, subsequent children tend to go the same route. If your first labor fails, on the other hand, and you end up with an ‘emergency’ C-section or if you ‘elect’ to schedule a C-section for either medical or social reasons, it is more likely than not that your next birth will be surgical as well.

There is a relatively small cabal of women, however, who have the special experience of both a vaginal and a Caesarean birth. I say ‘special’ with tongue in cheek because, really, this is not a club to which membership should be coveted. Each type of delivery leaves a new mother with its own unique souvenirs and it is an unlucky woman indeed whose body wears the evidence of both sets of war wounds.

I am tickled by the story of a friend who happened to mention during a gynecological exam the fact that she has two kids. The nurse, elbow deep at this point, stopped her mid-sentence, remarking with disbelief that her cervix was ‘far too pretty’ to have seen any children. Alas, her boys were born by C-section and though the scar may not be the most attractive, apparently it keeps your cervix looking fresh as a daisy.

There are basically two ways in which you can have both types of birth. (NB: I can’t bear to mention here the poor mother of twins who delivers the first normally and then is forced to deliver the second surgically, it’s just too awful). Either a woman who has managed a vaginal delivery at some previous point is faced with a novel circumstance that dictates a Caesarean (a breech baby, perhaps, or an unprecedented medical condition). Or, a woman who has had a Caesarian the first time round tries for a VBAC (‘vaginal birth after Caesarean’). This is what happened to me.

When I first spoke to the consultant in charge of my case (remember, this is the NHS where you don’t have the same doctor from appointment to appointment, never mind from child to child) about the possibility of a VBAC, the question he asked me straightaway is the critical one for any woman interested in such an attempt: why did I have the C-section in the first place? My sister’s answer to his question is that I am neurotic (feel free to take this up with her). The actual answer is the more typical tale of a ‘failure to progress’ after induction.

I didn’t love this doctor, but he had a savvy response to my description of the rather generic phenomenon of a stalled labor. It was a response I remember perfectly because it captured so well something of today’s increasing prevalence of C-sections: a failure to progress, he said, ‘is not a diagnosis, but an observation’. Okay. He then flicked through my chart to see what the more concrete medical reasons were. There were two: induction and a baby who was in the occipital posterior position (i.e. who was lying with his back to my back). The two reasons were not unrelated. The baby didn’t kickstart labor on his own because he was in the wrong position. Also, he had an enormous head.

None of these reasons was bound to recur so none was a deal breaker in terms of my ability to deliver vaginally this time round. I was given the green light to watch and wait. The condition, however, was that things had to proceed in textbook fashion. VBACs are not without (minor) risk and the minute something went amiss, I was warned, off to the operating theatre we would go.

The most important aspect of the plan was that I had to go into labor spontaneously. Because this is precisely what I failed to do with my first child - and as each day after my due date came and went with that pregnancy I became further convinced that he was never coming out - this was the part of childbirth I found the most elusive and also the most magical.

The beauty of labor starting on its own is not to be underestimated. Waters breaking theatrically in the middle of the grocery store, the tell-tale pang in the abdomen at the Thanksgiving table, the mad rush through the snow to get to the hospital in time. This is the stuff of movies and for good reason. Nobody wants to hear about induction, about the two lots of Prostaglandin pessaries I had shoved up my crotch over the course of 12 hours to yield a .5cm dilation which allowed, only just, a long, hard tool with some kind of hook on the end to be inserted far enough into me to rupture the bag of fluid surrounding the baby. It was hardly, I can assure you, a Hollywood moment.

I am amazed at women who lobby to be induced prior to full-term for non-medical reasons and I can only assume that these women are as unfamiliar as I was with the realities of induction. With what it means to stimulate (and simulate) with drugs a process so mysterious that, even amidst the great advances in obstetrical care, it still can’t be predicted with true accuracy, if at all. This is not to say that induction doesn’t work, only that if your body isn’t ripe for labor, it can often be a long and treacherous road to get it there.

But let’s cut to the chase. What people really want to know from a woman like me is the answer to the question: but which is worse? It really is a matter of pros and cons, but for blog’s sake I’ll try not to equivocate. The C-section is the harder recovery. As much as we would all like there to exist a ‘labor’ free form of birth that comes without repercussions, having your abdomen cut open is a major surgical intervention. It restricts your mobility, it leaves scar tissue, and it takes a while to heal. That being said, the vaginal birth is the potentially more traumatic. Stitches in your vagina are, well, they’re stitches in your vagina (I can’t even write that sentence without wincing). Damage to the nether parts is a trying experience: I might have been up and walking around shortly after my VBAC, but I couldn’t sit down for at least a week.

The point of birth is to get the baby out and in this respect it is certainly an arena where the result is what matters most. But it would be mistaken to deny the significance of the process too: how a baby comes into the world is our gateway to motherhood and this fact alone invests it with meaning. In the end, though, the details of your birth story often become less important than the fact that it is your birth story. And yours to tell, over and over again, to anybody who will listen.