QUESTION: I have one child and I am
expecting my second baby shortly. I am very anxious about the upcoming
birth. My first child was delivered by cesarean, but my doctor wants
me to try to deliver this baby vaginally. The mere thought of this
frightens me terribly. With my first pregnancy, I just knew I wouldn't
be able to deliver vaginally and was right. I'm also worried that
VBAC will negatively affect my sex life. Any suggestions?
ANSWER: If your obstetrician believes
you may deliver vaginally, he or she probably does not see any significant
physical limitations at this time. And certainly due to having already
stretched from your first pregnancy and labor, your body will be more
supple and responsive to the birthing process. Additionally, there
are health risks to you and your baby in a cesarean delivery. And
most physicians now believe that a vaginal birth after cesarean is
safe, and a preferred alternative to elective surgery.
A baby's descent through the vagina can be thought
of as a vigorous massage that prepares the baby for the world outside
the womb. Mucous is squeezed out of it's lungs for breathing and it's
skin is massaged for increased circulation. Birth by cesarean can
be a more abrupt transition for a newborn, particularly if there was
no or little labor preceding the operation.
It is natural to be afraid of labor. Horror stories
abound and childbirth is a truly vulnerable transition. But coping
with the natural pain of labor as well as using pain medication available
if needed can help you stay present through the labor in a way that
can also feel very positive and empowered. Many things can influence
your ability to cope with the birth, including associations to childbirth
that have been learned, or even your own experience of being born.
If you are concerned about damage to the perineum
(the area between the vagina and anal opening), talk with your doctor
about not having a routine episiotomy (automatic cutting of the perineum
for faster delivery of the baby). Michael Klein, M.D. chief of family
practice at McGill University in Canada conducted a study that documents
that without episiotomies, half of women deliver babies over intact
perineums. The other 50 percent generally suffer minor tears which
are easily repaired without damage to the perineum. However, when
women have routine episiotomies, Dr. Klein has found they continue
to tear into deeper vaginal tissue and result in more trauma to the
vaginal area.
Ask your doctor about his or her episiotomy rate and
whether he or she knows about the research which shows that women
fare better when not given routine episiotomies. Request that your
physician honor your request to not traumatize your body unnecessarily.
Or consider interviewing other doctors about their willingness to
support you in not having a routine episiotomy. Taking charge of your
medical care will help to ease your fear and empower you during this
very significant life event.
Research also shows the effectiveness of having a
"doula", a woman who is knowledgeable about labor and assists you
and your husband through the birth process. Education decreases fear.
Read books, go to classes, and talk to other women who have experienced
positive birthing experiences, including vaginal births after cesarean.
What do they say contributed to their ability to cope with the experience
and feel empowered by it?
Perhaps your overriding anxiety about labor as well
as your fear of becoming less attractive to your husband sexually
got in the way of your labor and birth preparation in your first childbirth.
It is true that significant fear can decrease oxytocin in labor, contributing
to dysfunctional labor and increasing the possibility for cesarean.
You can indeed resume a normal sex life with your
husband after a vaginal childbirth! Though it is true that your vagina
will be more relaxed, this does not mean less sensual. In fact, the
blood brought to the lower pelvic floor in pregnancy and childbirth
generally increases sensuality in post childbearing women.
Talk with your husband about your fears about the
changes in your body after vaginal delivery. It is his job to love
you and accept your changing body over time. Childbirth is just one
of the changes that he will witness if you live full lives together.
To avoid these natural body changes is to deny the reality and intimacy
of living.
It is also true that dealing with pain in childbirth
is a main source of fear for women. However the pain of labor is a
healthy pain, not the pain of something wrong, and it can be addressed
and mastered. As a society, we have difficulty accepting that something
intensely difficult or even painful can also encompass a feeling of
power, beauty and ease. Childbirth is such an experience.
Childbirth is an event of significance which impacts
a woman's developing sense of herself. Whether you deliver vaginally
or by cesarean birth, it is the process by which you give birth that
matters. Transforming fear by meeting the labor contractions can have
far reaching consequences on self esteem and empowerment in other
areas of life. Mastering fear can yield energy available for other
situations in life which challenge us.
