walkitout (walkitout) wrote,

Diana Korte, _The VBAC Companion_

Subtitled: The Expectant Mother's Guide to Vaginal Birth After Cesarean

If you've made it this far, you should have a pretty good idea of what you're signing up for by reading the rest of this review or, as the case may be, this book. Which I recommend, if you are contemplating pregnancy after having had one or more c-sections.

It would appear to be out of print, but is readily accessible used online; I got a paperback copy via Amazon. Copyright 1997, this dates from when ACOG was trying to get the c-section rate down in part by promoting VBACs instead of repeat cesareans. Likely due to litigation, ACOG has changed the guidelines since this book was published. This book and ACOG agree that in the event of a uterine rupture (and not the technical-rupture-than-no-one-cares-about but the real deal), best-odds for the baby's survival require emergency c-section within 17 minutes. The implication is not only do you have to be in a hospital that can do a c-section, but there has to be a team standing by, a point which is often glossed over. Many hospitals are using this as a reason to just not do VBACs.

ETA: Here's a response on ICAN to the 1999 guidelines change:


Many freestanding birth centers won't do VBACs and many midwives of varying credentials who might otherwise do a homebirth won't attend a VBAC homebirth for related reasons. Some of the ones who used to got their chops busted pretty hard if they had to transfer and their covering ob-gyn learned what they'd been up to. I'm still trying to decide if I'm quite clever for having lined up a birth center that will do a VBAC, or way out in the realm of risk-taking, so if you have some questions about my decision, let's just say we may share them. I'm not, however, interested in discussing them.

Which is not to say that I wasn't interested in better understanding. Given the number of books I've read about parenting, childbirth and pregnancy, it seemed a little wrong I hadn't read anything in particular about VBACs, other than the occasional on-line article that I could not help but roll my eyes at. I very much wanted to avoid certain books about VBAC on account of I'm pregnant and hormonal and just Do Not Need to Be Dealing With That Stuff Right Now. Diana Korte's better known for her _A Good Birth, a Safe Birth_ (which I got from the library and read while pregnant with T., IIRC). She never had a c-section, never mind a VBAC, but she's clever with the questionnaires and good at assembling data and presenting it in a well-structured fashion.

The structure is straightforward. She presents how many women got here (cascade), what they might be feeling (fear and loathing), and why a VBAC is something that is worth considering, even if it requires some effort. She then describes how to go about lining up a sympathetic health care provider/birth attendant and location, and figuring out how to get your insurance to pay for it. She lays out a variety of standard traps to watch out for (people who expect labor to progress rapidly) and some standard warnings about other birth/lactation unfriendly practices some hospitals still (at least ten years ago) engaged in. Interspersed throughout are quotations from the women who responded to her questionnaires about their experience. Korte does a really nice job of including the voices of women who Tried Really Hard and Did Everything Right (for suitable definition of Right) and still had a repeat c-section. Several call-out boxes list questions to ask various people when you are trying to identify your birth attendant/location/etc.

She even spends a few pages on how to have a good repeat c-section experience, if that's what you decide is right for you.

The back of the book is consumed by the usual resources listings and a copy of the questionnaire, should you choose to participate.

This book did a great job of what I wanted done (filled in terrain I had a rough sketch of) without doing anything I didn't want done (like, make me even more hostile to medical care as perpetrated in the US today).

Will I be taking a VBAC class? No. Will I be attending ICAN or C/SEC meetings? No. Will I take a childbirth class? Probably not. Do I even have an opinion about what anyone else contemplating what to do in a similar situation? Not especially. I know several women who really tried hard for a VBAC with their second and it did not work out for them. I know even more women who scheduled their repeat cesarean because there was no way in hell they were going through that natural childbirth ending in emergency c-section thing again. I know one woman who had two (premature) babies (more or less) naturally and both spent substantial time in the NICU -- I'd take a c-section over that in a heartbeat, not that anyone gets to make that choice. I even know one woman who decided enough was enough with this Bradley thing and on her third went in, got an epidural and was amazed at how smoothly everything went (well, DUH!).

With a little luck, sometime in September I'll be moaning in a tub of water. With a little more luck, I won't then be transferring with a stubborn cervical lip. But ya know, there are some hard limits to how much say anyone gets in a birth. And that's the nicest thing of all about Diana Korte. She's worked really hard to improve the birth experience for women, both by suggesting what they can do and advocating for change at hospitals where most births take place. And she has never lost sight of the fact that no one really gets to control how this all turns out.

ETA: I think it's actually really hard to write any book on this topic, much less what this book attempted (a moderate advocacy, informed by relevant studies). Most readers (or at least, most people who post reviews) are going to bring a lot of themselves to this book, and the filter may or may not do the contents justice. With that in mind, if someone has told you this book is a very balanced portrayal because you really want to have a repeat c-section, and they are really trying to convince you to do trial of labor, this book will almost certainly piss you off. Because that _person_ is pissing you off. Do whatever the hell you think is best for you, but try not to blame this book. If you are terrified of any degree of risk at all, and are looking for a VBAC advocacy book that says that there is _no_ risk at all to VBAC (or childbirth in general), this book is going to piss you off by pointing out some possible negative outcomes. If you _really really really_ want an epidural as soon as you start labor, and a fetal monitor because _that's how you knew you had to have a c-section or your first baby would have died_, then this book is _NOT_ for you. Stay away. But odds on, if you read my blog with any frequency, none of these things is true of you. ;-)

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