If you haven’t read my previous post about the risks of a trial of labor after cesarean compared to having a second cesarean, it might provide greater context to this post. To summarize, I was told by my doctor that if I wanted to try a vaginal birth I would have a 61% chance of it being successful. Sometimes referred to as TOLAC (trial of labor after cesarean) and VBAC (vaginal birth after cesarean).
In part one, I laid out the medical risks and my thoughts about them. I think deeply about my decisions, and this is one I have taken very seriously. I have laid out the risks pretty clearly for myself, and some seem more real and more threatening than others (the thought of a uterine rupture is much more graphically scary than the concept of post-surgical infection). But there are other factors that I’m also considering, beyond the medical risks.
For example, how it could impact having more children? Whichever decision I make, the outcome may have repercussions on the ability to carry future children, or on how those children could be birthed. But two things are still totally unknown, whether I’ll want another kid and whether this birth will even impact that.
Dr. K said she’s seen it all. She’s seen mothers have 5 successful cesareans. She’s seen mothers have two vaginal births and then need an emergency cesarean during the third child’s birth. She’s seen mothers need a hysterectomy because of vaginal birth complications. The point is, it’s all unknown and I need to make a decision that feels right to me, and not worry whether or not it’s THE RIGHT decision.
Another thing on my mind is scheduling. Oh how I love scheduling. With an elective cesarean I pick the date. Baby #2 can be born on his due date, February 18. Exactly a month before Max’s 2nd birthday. Adorable, neat and tidy. Two birthdays, Feb 18 & March 18. Easy to remember. My parents have already booked flights to come and stay for a month. I’d rather the baby be here for most of that time than have them here while we wait for labor.
Also, I hate waiting. GAAWD do I hate waiting. With labor you just have to wait and see when it happens. Urgh. And if it doesn’t happen by 41 weeks they might want to induce you. Induction comes with a whole world of issues. One medical intervention often leads to more and more. I’m glad it works out for so many mothers, but it’s certainly something I’m weary of based on the reading I did preparing for Max’s birth (before knowing he was breech).
I think I lean towards preferring a cesarean. I feel like it’s less risky because I’ve done it before. That’s not about statistics and medical risks, it’s about a gut feeling. I know this experience. That's all I know. Yes, it could be different this time around. But the prospect of labor and vaginal birth is way more unknown, and that’s scary to me.
Don’t Should on Yourself
But there’s something holding me back. There’s a voice in my subconscious that nags at me, tells me I’m selfish for making this decision, that I should try labor, that it’s the right thing to do. What is that voice, and where does it come from?
To me it’s a similar voice as the fat shaming voice, or the “breast(feeding) is best” voice. Subtle messages throughout society that bombard us about what is right and wrong. What is acceptable; what is desirable. How to be a "good mother".
It overshadows medical advice and statistics. It can even speak louder than the voices of friends and trusted loved ones who share messages of support and encouragement for whatever I want to do.
The voice is like a deeply ingrained feeling that childbirth should be through the vagina and should be “natural.” That’s how it’s been done for millennia, so you should do it that way. This messaging also impacts a lot of mothers who feel conflicted and ashamed about receiving epidurals - an often much needed pain relief during long and arduous labor.
Don’t “should” on yourself. I hear my friends and I saying to one another when we put excessive pressure on ourselves, especially around things we don’t really want to do.
Despite knowing and being able to see this voice for what it is, a bunch of rubbish. It still has an impact on me. Every time I logically get to the conclusion that I think a c-section would be better for me, the voice creeps in to say… but are you sure? Are you doing what’s best for your baby? Are you choosing an easy way out just because you are afraid of labor?
It was like this when trying to breastfeed Max. He clearly wasn’t getting enough food from me and I desperately wanted to make it work. Whenever we increased his formula intake, the voice told me there was more I could be doing to produce more milk. (The voice and the breastfeeding advisors I spoke to). Eat differently, relax, be happy, pump multiple times at night. Steve had to convince me that pumping all night was not working for us, but against us: causing me lack of sleep and increased anxiety.
I remember feeling huge relief when I gave up trying to increase my milk production. And an even bigger relief when I stopped breastfeeding & pumping altogether. When I look back, I just regret listening to that nagging voice for so long.
It’s written in the cards
This past weekend, I was visiting two friends in Sacramento. As part of our time together, we held a tarot ritual with the intention of releasing something. I wasn’t sure what to expect. Sometimes I draw tarot and what’s reflected in the cards doesn’t speak to me. This wasn’t one of those times though.
My friend Mary led our ritual, she came with a deck of cards, an interpretation book, and a candle for our releasing ritual. Our other friend, J, and I shuffled our energy into the deck. Mary laid them out across the table. All of us picked cards.
I picked three, choosing the cards my eyes were drawn to. I flipped them over one at a time to reveal the two of swords, the six of cups, and the knight of pentacles.
The two of swords is depicted by a blindfolded, seated woman holding two swords crossed over her chest. There is water dotted with little islands and the crescent moon in the sky.
This card is all about a decision that has to be made. The blindfold over her eyes represents confusion, that she cannot see the problem or solution clearly. The two swords are balanced, representing her careful consideration of the situation to find the best resolution.
Mary explained that the suit of swords is traditionally associated with the mind, but the water in the background represents emotions, suggesting that the woman has to use both head and heart to consider the options. The land in the water suggests obstacles and that the decision is not as clear cut as it seems. The moon is a sign that the woman must trust her intuition as she makes her choice.
As I heard all of this, I immediately thought about my birth plan decision. How I’ve been trying to weigh all sides of the options, but that there’s this big unknown - information I cannot see, because it cannot be seen. If I knew the outcome, it would make the decision easier for me. I appreciated the sign of the moon, suggesting I should trust my intuition.
The second card, the six of cups, is illustrated with a scene in which a young boy is handing a cup of flowers to a young girl. The card represents nostalgia, fond memories of the past.
Mary read from a large book that describes the meaning behind each card in the tarot deck. She said something about connecting with the past and your inner child helps you to connect with your intuition. It also came with a warning that while it’s nice to think fondly of the past, you can’t stay in it forever, you have to move forward.
I also read online an interpretation that sees the card as a representation of pregnancy, a birth and siblings who play nicely together. I thought this was really interesting, given the fact I’m pregnant with baby #2 and a lot of motivation behind having this baby was to make sure Max has a sibling.
I wondered if this card represented my reflections on my previous cesarean that went really smoothly, or if it was a representation of the inner nag voice telling me women have given birth vaginally for centuries and should be the way to do it.
My final card, the knight of pentacles shows a knight on a stationary horse, with a gold coin in his hands. Behind him are carefully plowed fields.
Mary read from the book: “He prefers to plan his path ahead before taking action… the plowed fields represent that the knight is willing to do the hard work to realize his dreams.” She read more about this card representing working methodically towards something, practicality, and responsibility.
I found this an interesting card to pull, especially relating to this decision I have to make. My desire for a methodical plan, a right decision/path to walk on. Also the tendency to prefer the practical and predictable - such as a scheduled cesarean.
It was almost like the universe had been listening to my conversations, in the same way Google does through our phones and then advertises certain products to us. The tarot picked up on my situation, on the conversations I had in the car up to Sacramento with my roommate, on part one of this blog post I had already drafted.
Releasing Ritual
J and Mary proceeded to read and uncover the meaning in the tarot cards that they had each pulled. Afterwards, we spent a few minutes journaling about our readings and focusing on something we wanted to release.
I decided I wanted to release the pressure I felt around this decision. To fully accept that I want to move forward with a second cesarean. It feels right for me.
I carved a small symbol of a stick person, to represent a baby, and a V, to represent VBAC, into the black the candle. Mary and J added their own carvings. We placed a few drops of a special blend of oil on various parts of our body, including our palms and did a moment of meditation to ground us. We rubbed our hands together and then faced that energy towards the candle so it would absorb everything we wanted to release.
I release the decision. I release the pressure to have a VBAC. I release the pressure I feel from the nagging voice. I release the burden of the decision, the feeling that if something goes wrong it would be my fault because I had made the wrong decision. By releasing this, I gave myself permission to no longer second guess myself.
It felt good. It felt really good. I think after processing in this way I was able to accept my gut and intuition. To trust myself when I kept circling back to wanting another cesarean.
A Decision Reached
The following morning I had a doctor’s appointment. A standard weight check-in, blood pressure check and listen-in on the baby's heart beat. Everything's looking good. I'm 30 weeks along.
Once we covered the essentials, Dr K pulled out a form and handed it to me, “Oh, we need you to sign this,” she said. I glanced at the form as she tried to verbally explain it. The form lists the risks associated with VBAC and elective cesarean births. The form ends with two boxes, one of which I must check and sign.
The two boxes are to indicate my preference for either a vaginal birth, box one, or an elective repeat cesarean section, box two.
For a moment, a wave of uncertainty came over me. Whoa, universe, slow down! I only just released this yesterday and now I have to sign a form committing myself to it?!
I blinked and reminded myself that this was OK, I knew what I wanted. There was nothing more that could happen that would bring me to a different conclusion.
No additional conversations with Steve or friends, no more research about medical risks would change anything, and there’s no chance of seeing into the future to know what that 61% chance of success would really mean.
I checked box two, signed my name and handed it back to Dr. K.
“Don't worry,” she said, “if you change your mind, we can just throw this away and you can sign another one.”
LOL
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