Gina Crosley-Corcoran could feel the ghost of a
knife slice her lower abdomen as she gave birth to her first child
by Cesarean section. Even the healthy birth of her oldest son,
Jonas, couldn't erase that haunting memory.
"Just lying on the operating room table and feeling what
was being done to me was a very traumatic experience," says the
Brookfield mother and pre-law student. "So when we decided to get
pregnant again, I knew that I wanted to have a vaginal
Crosley-Corcoran's feelings aren't uncommon among women
whose doctors say they need to have emergency C-sections, often
after hours of labor. C-sections account for 31.8 percent of births
in the United States and the rate has risen more than 50 percent in
the past 11 years.
That contrasts sharply with the World Health
Organization's recommendation that C-sections should account for no
more than 15 percent of births in low-risk women. The numbers can
be disheartening for women who know C-sections are major abdominal
surgeries that come with all the risks of any major surgery-and
they're being performed for reasons that have nothing to do with a
disease or medical condition.
"Birth is something we're all designed to do," says
Crosley-Corcoran, who started and leads the DuPage County chapter
of the International Cesarean Awareness Network. "It's not the way
it is on TV shows. It's not sensational. It's normally very
However, Crosley-Corcoran's battle to have a vaginal birth
after Cesarean, often referred to as VBAC, may be less common-if
only because many women don't know they have the option of fighting
for a VBAC.
In response to the heightening conflict, the National
Institutes of Health last year held a VBAC consensus conference.
Many women hoping to avoid repeat Cesarean sections are being
deprived of the choice, the conference panel announced. Though the
independent panel of health care providers and policy makers
emerged from the conference with new recommendations, those
recommendations are still largely left open to
The issue remains a subject of hot debate between women
who don't feel they should be forced into surgery and doctors and
hospitals that say the risks of VBACs-including uterine scar
rupture during labor-outweigh those of repeat
"We certainly support the concept of people having choice
and are happy to have people undergo a trial of labor, but I think
also we want to convey to them what the risks and benefits are in
their individual circumstances," says Dr. William Grobman, a
specialist in maternal fetal medicine at Northwestern Memorial
Hospital. "At the end of the day, what we want to be doing is
taking care of people, and I think we need to make the decisions
that are most about the patient."
The American Congress of Obstetricians and Gynecologists
has set guidelines "useful in identifying candidates for VBAC,"
including the immediate availability of a physician and
anesthesiologist should an emergency C-section become necessary.
Some hospitals that can't meet this recommendation have opted not
to provide VBACs.
Yet critics argue hospitals that can meet these
recommendations are still banning VBACs, despite the high success
rate of VBAC births in the United States, consistently between 60
and 80 percent, according to the National Institutes of Health.
They also cite the extremely low risk of uterine scar rupture,
which they say occurs in less than 1 percent of women.
Some health care professionals believe key risks involve
legal as well as medical issues.
After insurance issues hampered her attempts
to switch doctors during her second pregnancy, Crosley-Corcoran,
31, prepared for a struggle.
"(My doctor) wasn't going to support the things that
needed to happen for me to get my VBAC," she says. "I saw myself
going back down this road where I was just going to end up with
another C-section, and I knew I had to get myself informed and get
myself a really good support system."
Crosley-Corcoran began educating herself about birth,
hired a doula and even learned how to read a fetal heart rate
monitor. All were choices that helped her during the birth of her
second son, Jules.
When her contractions started at work one May morning in
2008, she immediately took a taxi to her doctor's
Crosley-Corcoran says she fought throughout her 38-hour
labor with doctors and nurses who said she needed another
"They kept trying to tell me that Jules' heartbeat was
becoming (too fast). Well, I knew what that was and I could see the
fetal monitor and it wasn't," Crosley-Corcoran says. "To me, the
most inappropriate behavior was the scare tactics."
Dr. Melissa Dugan-Kim, an OB-GYN at the Northwestern
Specialists for Women and Northwestern's Prentice Women's Hospital,
says in the last five years she has done nearly 300 C-sections and
200 vaginal deliveries.
Dugan-Kim, who also does VBACs, attributed the rising
number of C-sections to an increase in assisted reproductive
technology, which leads to a increase in twins and
"Everyone thinks they're going to get pregnant, have an
easy pregnancy and take home a healthy baby. That's not always the
case," says Dugan-Kim.
Jamie Grumet knew having a baby would be painful. But she
didn't realize how hard it would really be, she says.
"I thought you have a baby and it's so exciting," Grumet,
She arrived at Northwestern's Prentice Women's Hospital
late one evening in September. Things were slow to progress. A
nurse had to break her water early the next morning, and it wasn't
until mid-day when Grumet's doctor gave her the go-ahead to
"I was all excited," she says. But after an hour of
pushing, the baby wasn't moving.
Grumet's doctor told Grumet she needed an emergency
C-section because if she continued to push, she could risk breaking
her narrow pelvis.
"That 20 minutes between the time they prep you for the
C-section and you actually go into surgery was probably the worst,
scariest, most awful 20 minutes of my life," she says. "I knew I
was in good hands. It's just that I was so alone and they lay your
arms out on the table literally like Jesus on a cross."
Just 20 minutes after she was wheeled into surgery, baby
Ellie was born. Although Grumet understands her C-section was
necessary, she says her birthing experience didn't go as she had
Grumet's doctor told her any subsequent deliveries must be
via C-section, which has become such a common practice that 90
percent of women who give birth that way once will do so again,
according to the Illinois Department of Public Health.
"My doctor says for the next baby it'll be a lot different
because I'm having an elective, scheduled C-section. You can have
your Starbucks in the morning and have your baby in the afternoon,"
she says. "I think I would be mentally prepared, knowing I was
going into surgery, so I'd be OK with it."
More than 24 hours into Crosley-Corcoran's VBAC, her
doctor became more insistent that she needed a C-section. She
continued to resist.
Situations like Crosley-Corcoran's stem from a complex web
"I think it speaks to the many different pressures in our
health care system," says Grobman, who spoke at the NIH's recent
VBAC conference. "It has to do with regionalization of health care.
It has to do with, probably to some degree, the professional
liability climate. It has to do with societal attitudes toward
Cesarean and vaginal delivery."
It's a situation that makes it easy to blame the doctors
and hospitals that ban VBACs or pressure women to have C-sections.
But Grobman says that may not be a fair reaction.
"It's not that those hospitals are being mean per se, but
they're constrained by guidelines and circumstances. In that sense
it's not really necessarily their fault," he says. "It's really
system-wide change that people need to make … if people feel this
is an important thing."
While Grumet understands it's safest for her to have a
repeat C-section, she says she's still sad.
"I'll never be able to experience the way women have been
having babies forever and that's so sad," she says.
Crosley-Corcoran's experience turned out differently. For
her, the struggle was completely worth it.
"After my C-section, I felt like there was this thing as a
mother that I should have experienced, that I should have been able
to go through," she says. "Getting my VBAC and knowing that I did
it … it's just the most miraculous and powerful, unbelievable
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