Finding a Care Provider After a Special Scar

By Katie Perez

After a Special Scar cesarean, it can be a challenge for the woman to grapple with what has just happened to her.  She may feel betrayed, violated, angry, or even lucky, and just thankful her baby is alive.  The Special Scar cesarean is almost always coupled with this phrase: “You can never ever attempt a VBAC, or you will certainly rupture, and you and your baby will die.”  There is also a discussion about future pregnancies being limited to anywhere from 36-39 weeks.  I remember this.  I hadn’t even left the OR, and was hazy and disoriented from all the drugs, when the still-masked doctor peered over the screen and told me those words.

For many women, staying with the same care provider is simply not an option.  For many, a life sentence of preterm babies born by repeat cesarean is simply not acceptable.  And in all honestly, usually we won’t change the doctors’ minds, so moving on is the best bet.  Looking for a new care provider can be a challenge and it’s best to determine what you want out of your next birth.  If you are at peace to deliver a full term baby by repeat cesarean, then you will need to find a supportive provider who won’t want to deliver you at 36 or 37 weeks.  If you are at peace with a cesarean but still want your baby to choose his own birthday, or perhaps you want a more family-friendly cesarean with skin to skin in the OR and no separation, you will have to find a supportive provider to ensure your wishes are respected.  If you want to have a VBAC, then your very best shot at VBAC success is with a truly supportive provider, and the rest of this article will focus on that.

It’s no secret that finding a truly VBAC supportive provider for a woman who has had only a low transverse cesarean is a chore nowadays, so how much harder is it to find one who will take on a woman with a Special Scar? I’m not going to lie, it’s hard.  But with some determination, it’s possible!  I have watched the women of our Special Scars support group get told “NO” over and over and over again, and still persist.  Many travel distances of 3+ hours each way, for a supportive care provider.  Some even get prenatal care locally then relocate to totally different areas at the end of their pregnancies, staying with family, friends, or in extended stay hotels, all in an effort to have the very best care, and have a shot at what they believe is the very best birth for their little ones.

So what exactly does a supportive provider look like?  Well, whether you are planning a VBASSC, VBAC, VBAMC, or even just trying to prevent your first cesarean, there are some things your provider should do, and there are some definite red flags you should be on the lookout for.  For starters, ask yourself, does it seem like this provider is supportive of my plans, or just tolerant of them?  You really want someone on your side, who you won’t have to convince.  Someone with a track record of success, someone who isn’t nervous.  This provider should have a low c-section rate, a high VBAC success rate, and shouldn’t be quick to induce or cut episiotomies.  Those things tell you massive amounts about your provider.

Some obvious red flags are, “We’ll talk about it when you get closer”.  Uh uh.  Run from that person, they are setting you up for a bait and switch!  And restrictions such as requiring constant fetal monitoring, mandatory epidural placement, no food or drink, tethered to the IV, stuck in the bed, isn’t this how many of us get our c-sections to begin with?  A good provider won’t give your pregnancy a deadline of 39, 40, or even 41 weeks.  They won’t expect your labor to follow the picture perfect bell curve of the narrowest perfection.  They won’t limit you to an hour or 2 of pushing.  They just won’t!  Know how to sniff out one who isn’t going to give you what you and your baby deserve, and give yourself permission to walk away if you need to.

Many of our mamas chose to birth at home or at a birth center with a supportive midwife.  They don’t feel like they can safely deliver in a hospital again without running the risk of being dragged into the OR before they can even try to argue for a VBAC.  For many the thought alone of going back to a hospital in labor brings up enough stress to cause labor dystocia.  Birthing in the comfort of one’s home, without the risks that routine hospital interventions introduce, with a loving, nurturing, trusting midwife is a good option for many.

And believe it or not, it is possible to find a supportive OB!  I had my VBA3C with an Inverted T in a hospital, with a doctor who supported me the whole way and told me regularly that he believed in me!  These rare gems are hard to find, but they are out there!  I got the lead for this OB from a local midwife, he is her backup, and I’m forever grateful she pointed me in his direction.

What if all that is just not an option?  We do have some mamas who have fought the medical system all the way, and then gone on to VBAC with an unsupportive provider, even in hospitals that had VBAC bans.  Yikes is it hard to fight while you are in labor!  They have been told their babies would die, they would leave their other children motherless, they would rupture any minute, amongst all kinds of other abuse, all while in labor, and goodness, it takes a great deal of composure and pure determination to know better!  Definitely not ideal, but yes, possible.

We also have some mamas who choose unassisted birth.  Gasp, I know!  They are highly educated women at that.  A couple had medical training, one worked in the NICU at her local hospital.  They study, prepare and feel in their hearts that this is their best option.  While I realize this is highly controversial, we respect their choice!  The Executive Director of our organization had an unassisted birth for her second VBAC because even though she’d already VBAC’d on her scars once, there were still no care providers in her new area that would allow her to VBAC.

We at SS~SW are working hard to encourage more providers to support VBASSC’s, and we are in the very preliminary steps to begin our own studies to give more confidence in VBASSC safety.  While some studies do exist, they are mostly small, and not convincing enough to dispel the fears that even VBAC-friendly providers have.  NO woman should feel forced into a repeat cesarean, or into a cesarean earlier than she feels is safe for their baby.  Women have options, and they should have them more available, so every woman who wants to VBAC has the very best shot to do that!

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