My Journey to VBAC

Posted on November 19, 2009. Filed under: Cesarean, Elective Cesarean, Face First/Mentum Presentation, inverted t incision, vbac, VBAC after inverted t incision | Tags: , , , , , , , , |

I had a c section with Graham because he was left mentum transverse. This means he put his face into my pelvis first, sideways, with his chin on my left hip and his forehead on the right hip. This is considered a vaginally impossible delivery. I can pretty much attest to that as I had 52 hours of contractions without pain medication of any kind. I was upright and active the entire labor. I didn’t even go to the hospital until my water broke with particulate and thick meonium and even then I was 7cm. Because of all of this, it as very difficult to deliver him once the docs were inside so my uterus was cut a second time. The first cut was the standard bikini incision on the lower segment of the uterus and the second cut was perpendicular to that. It was a vertical cut extended into the contractile portion of the uterus. The result is an inverted T incision style scar on my uterus. This type of cut is reserved for emergency or very difficult deliveries. Only about .4% of c section end in this type cut.

American OBs quote the rate of rupture during a trial of labor in a subsequent pregnancy as 10%, 15% or even higher. It was originally recommended that any future babies were delivered by c section at 36 weeks after an amniocentesis to check for lung maturity. This was very disturbing to me on so many levels. First, I would be purposefully delivering a preterm baby. Graham gestated until 41 weeks and 1 day. By that reasoning, he would have been 5 weeks  early.  It was also concerning because if the rate of rupture was truly that high then was it even  sensible to carry another baby at all?

I started digging around and what I found was the most alarming thing of all. The true rupture rate found by the biggest study ever done on VBACs found a rupture rate of only 1.9%. How could it really be that low? How could I be told something so different previously? Where did the doctors that told me 10 and 15% get their info? I have no clue, I have never been able to find any reference  or study reporting that high of a rupture rate. It kind of made me mad and when I get mad I get determined.  I started reading everything I could find on this type of scar, why the cut is used, what doctors recommend and then I found that women did VBAC with this scar and they did it under the supervision of doctors and midwives that actually supported the idea.  I knew I had to find out all of my options before I could consider getting pregnant again.

I learned through ICAN of Atlanta that there is a doctor in Atlanta that would be VBAC supportive after an inverted t incision. He also support VBAC after multiple cesareans, VBAC after classical incisions, twin VBAC, and does breech vaginal.  His name is Dr. Tate.  I emailed him and talked to him months ago and he was on board when the time came. He was willing to take me as a patient, meet me at the hospital at the onset of labor, only require a saline lock and fetal monitoring and he would stay as long as it took with no pressure how long it took. He was willing to let my body work and do it’s thing without interference. He, like me, believes that the body is capable of birthing without intervention and time constraints and in a higher risk VBAC it is safer to be as hands off as possible.  The level of commitment that he was making touched me and motivated me and  I knew that was the answer. I could go back to the States in my third trimester and live at Ft. Benning and go to Dr. Tate in Atlanta. I finally had some peace of mind.

Then I found out I was pregnant on November 4th.

Yep, that’s right for  all of you that have been guessing, I am pregnant! Due July 15th. It is still very early, I am only 6 weeks along and I didn’t imagine announcing it so soon but I decided that I wanted to blog this experience and I was anxious to get started in case anyone else was going through something similar. So there it is 🙂

Once I found out I was pregnant my brain went in overdrive. I was already planning the move to Georgia in my mind and thinking of all the logistical aspects. I was bummed to have to separate my family for such a long period of time but willing to do it. I had decided that I would pretty much do whatever it took to make this trial of labor, my chance to VBAC happen. For me it is that important. I want my next baby to have a gentle peaceful birth. I want my body to experience labor and delivery the way it was meant to. I want to labor. I want to feel my contractions and my body work and my baby work in sync with it. I know it can do it. I am not afraid of labor, I had a very long labor with Graham,  I know that I can labor. I am not afraid to birth. I am surrounded by birth, I attend births, I know that my body can birth. I want that moment of realization that I birthed my baby myself. I want to hold my baby the instant it’s born, preferable pulling it out myself. I have had 19 months to process Graham’s birth but I will always hurt that he didn’t get to be with me for the first three hours of his life. How terrifying and confusing it must have been for him to go to the arms of strangers and bright lights and to be force fed formula rather than nurse. I want to give this baby a  more gentle entrance, it deserves that. I deserve that.

All that said, I am no fool. I know that I may have to have another c section. If the safety of my baby or my life is compromised, I get that. I have a lot of perspective and knowledge going into this next birth and I know that if we have another c section it is because it was truly necessary and I can live with that.

As all of this was coming out, my friend Karen, suggested that I talk to Dr. Chung. He is a Korean OB that has a solo practice and as the Korean’s say it he has gone the “natural way.” Women seek him out specifically for natural birth. Korea has a 45-50% c section rate and a 90%+ epidural rate for vaginal births. The “natural way” is small population in Korea. Dr. Chung also attends homebirths and has even attended homebirths on post at Yongsan Army Base. This is how Karen and I knew of him. It never occurred to me to ask him but I wasn’t aware that he attended VBACs. Once Karen told me this, I immediately emailed him. He got back in a couple days and said to come see him as soon as possible that he thought he could  help me.

OH MY GOODNESS!!! I couldn’t believe it. I may have the option to stay in Korea and do this! I had a question list a mile long. Everything had to be on my terms and my way. I want to do this but  it has to be as  safely as possible.  Here is the list of questions I used…

  • Approximately how many VBACs have you attended?
  • Of those patients in your practice who wanted a VBAC, how many were successful?
  • What do you think my chances are of a VBAC success, given my childbirth history?
  • What is your rate of cesarean sections and under what circumstances do you usually advise them?
  • Who is your back-up? Is he/she VBAC friendly? Would he/she support my birth plan?
  • What hospital(s) do you have privileges at? (Which would you recommend for a VBAC?) (Natural birth?)
  • What prenatal tests/procedures do you usually require? Recommend?
  • What do you think of Birth Plans/ Preferences?
  • How do you usually manage a postdate pregnancy? Or a suspected Cephalopelvic Disproportion (CPD)?
  • Do you have a vacation scheduled near my estimated due date?Labor & Delivery
  • What’s a reasonable length of time for a VBAC labor if I’m healthy and my baby appears to be healthy?
  • Do you know any kind of restriction I should expect from the hospital on a VBAC? (Who do I need to have policy exceptions approved through?)
  • How many people can I have with me during the labor and birth?
  • How do you feel about doulas?
  • What is your usual recommendation for IVs? Pitocin? Confinement to bed?
  • What’s your approach if the bag of waters has broken at full term but the mothers feels no contractions?
  • In what percentage of your patients do you induce labor?
  • Approximately how many of your patients have un-medicated births?
  • If my baby is breech will you still consider me for a VBAC? ECV?
  • At what point do you arrive at the hospital during labor/delivery?
  • What labor positions do you recommend to your patients? Do you encourage movement during labor?
  • I do not intend to push on my back. I may stand, kneel, squat or get on my hands and knees. How do you feel about this?
  • I would like to push spontaneously and without coaching or counting. I would like help breathing my baby out to reduce tears. Will you do this?
  • Do you require continual fetal monitoring for VBAC?
  • Do you allow light eating/ drinking during labor?
  • Are you OK with No IV – but a Saline Lock?
  • I would like a for my labor room to be quiet and undisturbed unless medically necessary. How do you feel about this and can you advocate for me to the hospital staff?
  • In the event that I need a c section and there is time, will I be able to have spinal anesthesia rather than general?

The conversation went even further than this list of questions.  I spent well over an hour with Dr. Chung yesterday. I was very pleased to learn that he would be willing to show up at the hospital with me at the onset of labor and stay until about two hours after the birth. NO MATTER HOW LONG IT TAKES. There will be no time restrictions. He said that he envisioned his job in my labor and birth as a back up. He said that he felt like he should be there with  me and if I need him he will be there. I will be laboring unmedicated so that I can feel any changes to my scar if there are any, and he can respond quickly because he will be in the room with me. He said that he understood the need to labor undisturbed and peacefully so he would be sure to keep staff out of the room unless medically necessary and that he would be an unobtrusive and quiet observer unless medically necessary. He has attended Hypnobirthing training and could certify as a Hypnobirthing practitioner if he wanted and that really got me excited. I am going to be using Hypnobabies and while the programs are different they are similar enough in that the laboring women requires peace and quiet and he totally gets that and is on board. He also said that his job was to let the staff know that my case is a special situation and while we do want little interruption that everyone should be on guard to respond to an emergency at any time. I will be doing this at a very large university hospital in Seoul that is also the most natural birth friendly hospital in the city. There will be pediatrics, NICU, anesthesiology, adequate nursing staff and a back up OB in case I get into trouble.  I am also A+ which is great because that blood type is abundant in Korea.

I cannot think of a more perfect scenario given my circumstances.

I would normally be very wary of going to the hospital at the onset of labor and laboring with my doctor present the entire labor but I truly believe that Dr. Chung is going to give me adequate  space and time. I don’t believe that his presence will pressure me. I think it will reassure me. Because I know that he isn’t going to put time restraints on me and he will not augment labor in any way, that I can relax. For me, because I have never had a vaginal birth, I need that security of immediate response and there are not many doctors in the world that commit to a patient the way he is committing to me.  I know that if I have another c section it will be because it was necessary. I know that he believes that my body can do this and that my body can birth but that if there is trouble he is prepared to repsond accordingly. With that kind of support, I know that I can labor quietly and peacefully and without worry.

So, like my friend Karen said yesterday, I have all the pieces in place, now it is time to switch gears to “I CAN birth my baby” and leave behind the “what if something happens.” She is right. I am ready. I can trust that I am in good hands and in the best case scenario possible for a trial of labor.

For me and my family, this is the best decision and one that I have been working on for a long time.  After Dr. Chung and I finished talking yesterday he did an ultrasound and I saw the little tadpole. It finally hit me that I was rally pregnant and not just planning any more 🙂

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31 Responses to “My Journey to VBAC”

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OMGosh! Amy that is all so exciting! I can’t believe after all you were told after Graham was born that you are going to have this opportunity. What a blessing! Congrats to you and Josh on your new little nut! I hope that everything goes well for your family!

Congratulations, Amy! I am SO excited for you and also amazed how you find these amazing flexible doctors! That’s great! So glad you are documenting your journey via blog – you will inspire many. I have been pleasantly surprised at the positive response of friends and family to my VBAC plans.

Hello!
Thank you so much for your article. John and I are currently pregnant with our first child and, like you, we live in Korea! Our plan is to have a home birth back in the states (we’re due June 30th and I’ll be heading back to America in May). And as you already know, ‘natural births’ much less home births are not common here in Korea, and so finding a doctor who understands our desires and is committed is near to impossible to locate. So I was wondering if you could send us Dr. Chung’s contact information? It’d been so encouraging and helpful to find a doctor who supports our decision and can give us information we need and not just the typical Korean hospital response. Thank you so much!
Sincerely,
Nikole

Congrats Nikole! Dr. Chung’s website is http://ubclinic.com/eng/sub_010101.html His number (English liason) is 010.2954.9400 and his email address is ub@ubclinic.com
. Like I said in the article, he does do homebirth. He also works closely with a homebirth midwife. Her name is Rosa and I know of several people who have used her if you want references. Her contact info is TEL 031-410-8597 HP 019-447-8231 ojkim80@hanmail.net These two are doing really great work and a lot of people have a lot of good things to say about them. There are also several birthing centers with midwives if you are interested in going that route. And one other thought, I do know of an English speaking Korean doula (she attended a childbirth education seminar that I hosted a few weeks ago). I am going to be using her to communicate with the staff at the hospital. I also know of a Canadian doula that speaks Korean if you want her info. You definitely have options if you would like to stay in Korea. Good luck and please keep me posted on what you decide!

Oh, Amy! I’m so happy for you! I only hope that I am so lucky to find such a supportive doctor when the time comes. You have been such an inspiration to me through your journey. I love your list of questions. I will be looking those up to use in my interview with prospective doctors. Best of luck to you!

Thanks Michelle! You will find a great doctor. I will tell you though, it takes time and perseverance. Start before you even get pregnant. I had found one that I was ok with which is why I began the TTC process. Once it happened I was lucky enough to find some one who I think is even better. Also, hire a doula early on, someone good and someone who’s been in the area for a while. Birth educators and midwives and doulas all run in the same circles to they will know who to refer you to. That’s how I found two docs supportive of my situation. This is truly a case of knowing the right people and asking the right questions. And best of luck to you!

Congratulations! I am so happy for you! It is awesome that you found the perfect doctor!

Amy! I am so happy for you! Congratulations! I am so excited for you! You will be in my thoughts and prayers!

Oh Amy, congratulations!! That is such exciting news!! I am so, so glad that you were able to find such a wonderful ob in Korea and will be able to have your family with you at the end of your pregnancy! Wonderful!! 🙂

YAY!!!!! Congrats Amy, how exciting! 🙂 Thank goodness you found a wonderful doctor that is willing to listen to your wishes…Already can’t wait to see the newest addition!

It truly is the honor of my life to support you on this journey.

aww, thanks! I do know what you mean though, I feel the same way when I attend a birth. By the postpartum visit, I almost feel bad for taking their money after the time I spend with then and how honored I feel to have been a part of it.

But really, I couldn’t think of a better support person than you. THANK YOU for doing this!

Congrats Amy. This is so exciting. I am so happy things are working out well for you.

Wow!! Congratulations Amy!!! pregnant, birthing doulas all over the place! i did the hypnobabies homestudy here in korea, too and birthed the ‘natural way’ (ha ha ha) in a midwife’s birthing center. . . i really loved doing the hypnobabies program everyday–the nutrition, exercises; the hypnosis was my favorite part of my day~~ best of luck in pursuing a healthy, comfortable pregnancy and birthing!! >.<

Any Hynobabies tips you have are welcome. I am all ears. Gotta love the ‘natural way’! 🙂

Hi, I found your blog from Mama Seoul. I got the info about her blog from a friend who was helping me to find information on having a VBAC in South Korea. We’re due at the same time. I found out I was pregnant when I got to the states for my vacation. My daughter was born via cesarean back in December of 2005. Her birth was a horrible, traumatic experience for me and I’m really nervous about all of this. I was really thinking of trying to find a way to come back and have a HBAC but I don’t really know anyone who could take me in for the time I would need to stay with someone. It’s just all been kind of scary for me since the pregnancy came about a little earlier than we planned. I look forward to reading of your journey and hope we can be due date buddies. I’ll be back in Korea December 8th but feel free to email me before that. I live in the Jukjeon area of Bundang/Yongin.

Hi Janeen,
You have some options here in Korea, especially if you had a low transverse incision with your first c section. I’ll email you.Have fun on vacation!

I am back in Korea now. Definitely freaking out at the moment, just a lot I’m worried about especially since our place is so small and…I don’t know, just a lot of stuff I’m dealing with in general. But yes, I do believe that it was a low transverse incision and I know my OB said I COULD have a VBAC with the next one and I don’t think she would have said that if I didn’t have that kind of an incision. It also seemed to heal well, with no problems. Support is going to be the big thing though. I didn’t have much support the last time around and I know that was a good part of what lead me to a cesarean. It for sure lead me to going to the hospital when I was barely more than 2cm.

Congrats!! Your new little one will only be a month younger than mine. 🙂 And I’m sure we will both be having fabulous VBACs! 😉 I’m so glad you don’t have to fly half way around the world to get your VBAC but it would be great to tell some of those moms that ask “Is it really worth it to drive to a care provider/hospital that is an hour away?” rofl Um, yeah!

I can’t wait to add your VBAC story to my page!! 😉

Thanks Jessica! I had been meaning to email you and tell you but I have been way too busy and nauseous lately. blegh. I’ll be looking for your VBAC story for inspiration:) I am glad I am not going back to the States too but you are right, it would have been a hell of a story. I still would prefer to UBAC but I decided that since I haven’t had a vaginal birth at all that I don’t have the confidence level that I need. I went with my gut on it and I think that finding the right doc helped since I dont’ really have to fight for what I want. Goes a long way I think. Anyway, I hope you are feeling good. Things are going MUCH better than the last time I talked to you 🙂

I’m so glad to hear it! 🙂 I totally understand about a UBAC, it does take a lot. You are going to hire yourself a doula, right? lol Just because you are a doula, doesn’t mean you won’t need one while you are in labor. 😉

I think once I have done it once, I will be good to go. And yes, I will have a doula. Actually, I will have TWO doulas. One is a friend who is trained as a childbirth educator but not formally trained as a doula. Regardless, she is by far the best support person I could have considering our collective circumstances. You can read her post about it here…

http://cairomama.blogspot.com/2009/11/birthing-is-journey-woman-who-serves.html

She actually DID go back to the states to VBAC and then had to change care providers and go two hours away because her baby was breech. She ended up having a successful version but her story is a great example of how far someone will go to have the birth they want.

The other doula is a new Korean doula who was trained by the LCCE trainer for the seminar I hosted in October. Janice (her english name) will be a great asset to my birth team in helping communicate to the staff and admin at the hospital.

Then of course, I will have my Bradly trained husband who went through 52 hours of labor with me already. And lastly my Hypnobirthing trained homebirth OB.

I think I did good 😉

Hi, I’m PunkRockChic from WTE Sept 08. My SIL referred me to your blog. She’s from the WTE March 08 boards. Firstly, I LOVE your blog and can relate to so much of what you’re saying. My son was born in Sept 08 via “emergency” c-section due to “nonreassuring fetal heart tones,” “failure to dilate,” and “macrosomia.” My son’s heart rate dropped any time they gave me Pitocin. Once the Pitocin was stopped his heart rate went back to normal. I checked in to the hospital at a 4 and was at an 8 when they wheeled me in to the OR 11 hours later. I did have a big baby (10 lbs 8 oz, 23 inches) but I never got the chance to labor. My son was posterior, so when I was at home, my back was a little achey so we went in cuz I thought I might be in labor. I was 4 days shy of 40 weeks. As soon as we got there, they started an IV (after 9 tries and 8 blown out veins). Then they did the epidural (it took 2 tries to get it right). I feel robbed and really pissed off about my cesarean because I never got the chance to try to push him out. My OB came into the room and said that a cesarean was medically necessary to ensure the health of my son. I am pushing for a VBAC like you would not believe with my next baby. My DH and I are planning to TTC next summer. Anyway, this got way longer than I intended. I just wanted to say thank you for sharing your knowledge and wisdom and that I think you are incredibly strong. I hope and pray that you get your VBAC for you, your new baby and to prove the “experts” wrong. I have become a follower and plan on visiting lots more. Your blog has definitely been a source of encouragement for me.

I just saw this, thanks for reading! Good luck with your VBAC research. Please keep me posted on how things go!

[…] Dr. Tate is the doc I would have used if I were going back to the States to VBAC. Instead I found Dr. Chung here in Korea who is, in my opinion, even better than Dr. Tate but both men are amazing docs with a calling to […]

[…] body the best shot possible and nutrition is something I have direct control over. Luckily, I have a holistic minded OB who supports my ideas and I am […]

Hi! I think you’re story is very awesome and encouraging! I have a question for you… how did you go about finding a VBAC/natural birth doctor in Korea? My husband is currently stationed at Camp Casey and we’re waiting to hear if he’s been approved for command sponsorship. I’m currently 13 weeks pregnant and will most like have to go off post for medical services. Camp Casey is located in Tongduchon which is about an hour north of Seoul I believe. I was wondering if you could give me any advice in trying to find a VBAC friendly dr in such a short period of time (if i go over i’ll be around the end of my 2nd trimester). I was so excited I came across your blog! Good luck with the rest of your pregnancy and your VBAC! I hope everything goes well!

HI Hana,
I’m actually at Camp Casey. Most of the moms here at Camp Casey have their prenatal care at the TMC (clinic on post) and at 37-38 weeks they transfer care to the Army hospital in Seoul in Yongsan, the big base there. It is about 2hrs by bus and 1.5 on the train. At 38 weeks you have the option to move up to the Stork’s Nest, it’s a free place right next door to the hospital that the Area I (basically people like us who are farther away) moms can stay so that they are close by when they go into labor. Most of my clients check in and get the key when it becomes available at 38 weeks but they don’t actually go stay there until closer to their due dates or even not at all sometimes. Most of them use the room to labor in for as long as possible before they go to the hospital, the longest I have been with a client in the hospital (with the exception of one who was a different situation) was three hours before she had her baby. The other option is to use the local Korean hospital (St. Mary’s) about 45 minutes away but I don’t recommend it. I have had doula clients deliver there but it’s just too different culturally and the birth experience tends to not be as great. 121 (the Army hospital at Yongsan in Seoul) does do VBAC and I have attended VBACs there with clients. The staff is great and while you do have to speak up for what you want they do tend to be pretty flexible. Their VBAC requirements are saline lock and continual monitoring. I am not having my VBAC there because of the type of scar that I have, they have risked me out as a good candidate as far as their staffing and blood bank is concerned. I am using a natural birth Korean doc that primarily attends homebirth and have access to a University hospital which is much bigger than 121. For someone who has a regular bikini cut scar, I do recommend 121, like I said, they are doing a great job there for the most part. Either way, you will have to go to Seoul. Dongducheon doesn’t have a hospital and like I said, St. Mary’s in Uijeongbu is pretty bad. If you are interested in the natural birth doc (and the hospital he delivers at does water birth 🙂 get in touch with me. Tricare only covers 80% of his fee, just to give you a heads up.

I also teach childbirth education classes. My last class is about to begin and I’ll be taking a break until September. When is your due date? You should come to my September class. Are you on Facebook? We have a group called Pregnant Army Wives in Korea and another called Army Wives at Camp Casey (or something like that). There is a lot of good info on both pages. My email address is amyncarter at msn dot com if you need more information.

Hello! I’m a migrant here at Dongducheon, just
moved in last April 27,2010.
I’m 10weeks pregnant now & due on Jan 2011..
I’m afraid to give birth in Korea but reading
your blog on having a Doula somehow ease out
those fears. I have not talk yet the
idea with my husband and I’m not sure we we can afford to having one. Anyhow,
Can you refer a Doula, someone from Dongducheon..
I understand you will be leaving by Jan2011 and
I can’t have you to help us.
Congratulations on ur pregnancy & thanks for putting up this blog 🙂
I hope to hear from u. Tnx!

Hi Sherly,

There are no there doulas in Dongducheon. I will actually be here until June 2011 but I’m not sure i’ll be taking clients. I do have some doulas that will be able to travel here though. Do you know where you are birthing yet? I am assuming most likely in Uijeongbu or Seoul since there isn’t a place in Dongducheon. Home birth is also an option if you are interested. I see you friended me on FB, message me there and I’ll help you explore your options. After I have my baby I can meet with you and I’ll resume my childbirth education classes in the fall and you are welcome to join, they are designed for couples.

Thanks,

Amy

Hi, I’m looking to have a VBAC however, my birth interval is 15 months where the recommendation is minimum 18 months. I live in Jeonju, South Korea and I am wondering if VBAC is possible here and where in Korea this would be supported. I know I can VBAC as I know I could have avoided an emergency c-section had I been more prepared and supported during my first birth. I look forward to hearing from you.
Rachel


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