Hélène Vadeboncoeur’s book, Birthing Normally After a Cesarean or Two, is written with the compassion, sensitivity and personal guidance of a mother who has herself experienced a traumatic first birth by cesarean and a second empowering and healthy normal birth. It is also written with the credibility of evidence-based research. Vadeboncoeur does not pass judgment on women’s choices and chooses to use the word “normal” simply as a substitute for vaginal birth. Written specifically for mothers, this comprehensive, well-researched and well thought-out book can also be a valuable resource for midwives, nurses, childbirth educators and doulas. Vadeboncoeur’s book was originally published in French.
Dr. Vadeboncoeur searched long and hard through her personal journey to better understand what led to the cesarean birth of her first child and why that experience impacted her life so profoundly. Her pursuit of a Ph.D. after the birth of her children was in great part a means to conduct research into the maternity care system and the high rate of cesareans . Although it was challenging for her to find a care provider to support her wish for a normal birth in her second pregnancy, she found that experience to be transformational. That is why she wants women to know that it’s possible for them to avoid a routine repeat cesarean and have a safe normal birth.
The book begins with an assessment of the historical and current perspective on cesarean and VBAC. How the beliefs of the day regarding the safety and indications for cesareans have changed in the last three decades and how widespread non-medical indications for cesarean have increased the cesarean rate. Cesarean section, the most common major operation in the world is examined within the current climate of fear of childbirth, the undervalued process of normal birth and the highly charged medico-legal climate in the United States.
The author believes that birthing decisions should be made by women and their partners and writes in her Introduction, “We women need to have our say because we’re the people most immediately affected by birth.” Vadeboncoeur’s respect for women’s autonomy and empathy for each woman’s personal journey towards making a decision about how she wants to give birth is reflected throughout the book.
She presents factual information and her personal point of view without judgement. Her guide offers women a balanced view of the benefits and risks of repeat cesarean and VBAC. Even women who decide that a repeat cesarean is best for them can benefit from the advice given about how to have a satisfying cesarean birth.
Mothers considering a VBAC will get an honest estimate of the level of risk that they are likely to face and how likely they are to give birth on their own. The author also covers a wide range of issues that are likely to affect a VBAC – having had one or more cesareans, the time interval between the current pregnancy and the prior cesarean, whether or not labor is induced, having had a vaginal birth and if single or double layer sutures were used to close the cesarean incision.
Dr. Vadeboncoeur makes a convincing case for why it’s worth the effort to consider a normal birth after a prior cesarean. Overall, VBAC is safer for women than major abdominal surgery especially if they are considering having several children. Normal birth makes it easier for babies to adapt to extra-uterine life, breath on their own and begin breastfeeding. Mother-infant attachment is more likely to be successful. Emerging research is also helping us to understand the complex science of hormones and the significant part they play for mothers and babies during the process of normal birth.
Throughout the book Vadeboncoeur shares with women that giving birth normally can be an empowering, transformative and fulfilling experience when they work together with their care provider to plan the birth experience they want. Women considering a VBAC will find useful and realistic information about how best to prepare for a VBAC- before and during pregnancy as well as during labor and birth.
Given how difficult it is in North America today to have access to caregivers and hospitals who support vaginal birth after cesarean the author also provides her readers with advice about how to increase their odds of finding a supportive provider and how to reassess the need for medical interventions proven to reduce their chances of having a normal birth.
Birth is a powerful emotional and psychological experience that impacts women’s well being, their self-confidence and self-esteem and their capacity for early parenting. To help women explore and understand how their cesarean may have impacted them and to help them heal from a traumatic birth Vadeboncouer writes with compassion and wisdom about the value of revisiting their experience so as to better prepare for a normal birth. “It is possible that some of this book will shock you,” she writes. “That emotions about your previous cesarean(s) will resurface for the first time, or that they will re-emerge, even if you think you’ve put those feelings behind you. Don’t let that stop you. As you will see when you read the birth stories in this book…this is perfectly normal.”
The book is enriched by many birth stories of women who have had a wide range of birth experiences. Personal accounts of women who began searching for a VBAC-friendly provider soon after their first cesarean as well as of women who, reluctant at first eventually did labor for a VBAC. We also read about the women who labored for a VBAC but ended up needing a cesarean. Vadeboncoeur’s own personal birth experience and the stories that are weaved throughout the book give an honest account of what women experience when seeking providers, a safe place for birth, and support for labor. Above all, the stories are testimony to what women can accomplish despite the many obstacles they find in a health care system that stacks the odds against them.
Fathers as well as mothers will also find Vadeboncoeur’s partner’s honest account of his experience of the birth of his two children very valuable. Although both children are now adults, it is revealing to find out how birth is also vividly remembered by fathers. Although Steve was a constant companion throughout both of Hélène’s pregnancies and births he admits that during the first long birth that ended with a cesarean under general anesthesia he at times felt “a sense of impotence.” When finally the couple found a supportive provider that would “allow” laboring for a VBAC the conditions at the hospital were not quite as expected. The staff reflected anxiety and fear. “We did not experience this VBAC in peace and harmony,” Steve writes. “It was almost as if we felt that having a VBAC was a sin.”
This valuable book is available in both an American and a British edition. My only reservation is that having read Vadeboncoeur’s book in French, as originally published in Canada, occasionally I found myself, while reading the American translation, occasionally stumbling over a sentence or two that lacks the natural flow and cadence of the English language. Overall, this comprehensive, well-researched and sensitively written book is a real find.
To find out more about Hélène Vadeboncoeur’s book and her perspective on normal birth and cesareans, read her Three-Part Interview on Lamaze International’s Science & Sensibility blog.