The Slow-Cooked Sentence

My family and friends made me a string of beads at my baby shower that I keep running through my hands, caressing each bead’s smooth or bumpy shape, watching the colors glisten in the sunlight. It is beautiful, and all the love it symbolizes is reassuring, because there is a risk with this pregnancy that didn’t exist before, a scar that stretches like a dark smile just above my pubic hair that is evidence of the cesarean I had six and a half years ago.

I plan to VBAC, a decision that runs in direct opposition to the majority of the doctors who share on-call duties with my obstetrician. Should I go into labor this weekend, the two doctors who would meet me at the hospital are severely opposed to vaginal birth after cesarean. “Be prepared for a fight,” my OB warns. And so I have prepared — an alternative. My midwife, Diane, is a short, round woman with burnished hair and a contagious laugh who has birthed hundreds of babies. She and her two apprentices will come to my home and together we will bring this baby into the world — gently, safely and without condemnation. My doctor knows of my choice. He acknowledges that it isn’t science that holds sway over his colleagues but the fear of medical malpractice lawsuits that has them frowning over VBACS.

Granted there is risk to the mother and baby when a uterus — once cut and stitched back together — is asked to clench and stretch its muscle again. The chance that the scar will rip open is 0.7 percent or 7 in 1,000 women, according to the International Cesarean Awareness Network. In addition, there is an increased risk with each cesarean that the placenta will embed into the wall of the uterus and cause the woman to hemorrhage. The American College of Obstetricians and Gynecologists recommends that a doctor be immediately available for a woman choosing to VBAC.

For most doctors, this recommendation carries too great a risk to their livelihood, so they pressure women into cesareans. At one point, my own doctor said he may ask me to sign paperwork that spelled out a VBAC’s risk in graphic language before agreeing to perform one, but he didn’t acknowledge that a cesarean carries its own chance of catastrophe or death until I pressed the issue. Cesareans account for 29 percent of all U.S. births, and this week some researchers placed partial blame for the spike in maternal death rate — the highest its been in a decade — on this major surgery.

Shame on the doctors for forcing me to choose between home birth and cesarean, when most agree that the safest place for me is to VBAC in a hospital with a supportive staff. I am scared over these risks, no matter how small, and frightened of these doctors who would judge me harshly, and so I run my fingers through these beads and pray.