Method of Birth Should Be a Choice

An Open Letter to an Obstetrician

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Some of you may know that our local hospital, Cottage Hospital, has a “ban” on VBAC (vaginal birth after cesarean section) despite that going directly against ACOG (American College of Obstetricians and Gynecologists) recommendations. Because of this ban, I believe the majority of Santa Barbara obstetricians (OBs) are not giving women informed consent when it comes to letting them know all of their options of birthing after a cesarean, including all the risks and benefits of multiple cesareans as well as with VBAC. In addition, some OBs are actually misinforming women about the capability of their own bodies to bear children vaginally, as is what happened to me after my first birth. Women deserve to know their options, to make an informed choice. Some women may still choose repeat cesarean due to medical or personal reasons. Some women may want to try for a VBAC. The point is, it should be a choice. Women should not feel railroaded into a medical procedure they may not actually need or want.

Below is my open letter to the OB who performed the cesarean birth of my daughter in 2015.

Dear Dr. R,

Guess what? I did the impossible: My “incapable body” gave vaginal birth to a perfect and healthy baby girl.

You see, in 2015 you performed a cesarean section for the birth of my first child. It was a long and difficult labor, and I’m exceedingly grateful that we have the modern medicine, skills and technology available to perform such procedures when necessary.

However, at my two-week post-op appointment I asked you about vaginal birth after cesarean). You laughed and patted my arm like a silly child, “Don’t you think you did enough the first time?” you said. You went on to tell me my body was “physically incapable” of vaginal birth.

“You feel this?” you asked as your hand was up inside of me, jabbing either side of my vaginal canal. “These are your bones. They are way too small for a baby.” And you sent me on my way.

Dr. R, your words were devastating. 

What?

My body … is incapable? My body is a failure? This perfectly created temple, this incredible vessel that grew another human being is defective?

I thought it didn’t happen this time because sunny-side-up babies are hard, because my cervix was swollen, because my blood pressure was rising. You’re telling me it’s because I’m incapable? How dare you say that to me in my most vulnerable state. You left me feeling raw and broken, the freshly stitched wound to my womb aching. I left that appointment in tears.

Luckily, I’m not someone who accepts being told facts about my life without assessing it for myself. I started reading about this physical incapability: cephalopelvic disproportion or CPD.

Wow, how crazy is it that I have this incredibly rare pelvis malformation!

And then the most interesting thing happened: I met one, two, five, seven — all these other women who also mysteriously suffered from the same thing: they were too small and incapable of vaginal birth.

Wow.

It’s truly amazing that American women are able to birth vaginally at all as it seems we have a CPD epidemic going on. How could so many women I know just in Santa Barbara all have this incredibly rare disorder? So many women, all lining up for their second, third, fourth cesareans, all believing their bodies weren’t built to give birth, believing this was the only option to bear a child. Once a cesarean, always a cesarean, right? It broke my heart.

I started talking to people, to midwives, another OB, to birth workers. I started asking questions. I got a second and third opinion on my pelvis size. And you know what? They all told me what you didn’t. They all told me my pelvis was perfect. They told me occiput posterior babies are hard. They told me I am a fantastic candidate for VBAC. That every birth is different, and position can make all the difference. They told me the only way to know if it’s possible is to try. They told me I have options, that I have a choice.

Dr. R, why didn’t you?

On February 4, I had the most beautiful and gorgeously intense VBAC experience I could have ever imagined. My daughter came into this world weighing a full pound and a half bigger than her sister (9 pounds of love!) with a head in the 90th percentile — all through my perfectly capable pelvis.

Dr. R, this letter isn’t meant to shame you, point fingers, or elicit any sort of apology. This letter is actually meant to thank you. Thank you for waking me up to realizing that doctors are just people, too. That we all are products of society and cultural influences, and unless we dare to assess and verify, ask hard questions, and decide to do differently if something’s not ringing true for us, we fall susceptible to perpetuating societal norms that may actually be incorrect or not in our best interest after all. Thank you for igniting a fire in me to be my own advocate and not just follow doctor’s orders. Thank you for giving me a voice in this ever-important topic of maternal health.

If there is anything I wish to leave you with, it is this: women deserve the truth. Women deserve informed consent. They deserve to know about all the options, all the choices available, about all the potential risks and benefits, not just the ones that are convenient or the ones you are told to give. We deserve better.

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