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(CNN) -- On Thursday, December 2, as Aneka sat at home nine months pregnant,
the phone rang.
It was her obstetrician wanting to know where the heck she was. Did Aneka
forget that today was the day for her cesarean section? How could she have
forgotten?
No, Aneka hadn't forgotten. She hadn't shown up intentionally.
"She told me, 'You're being irresponsible. Your baby could die. You could
die,'" Aneka recalls. Then the doctor hung up.
Aneka (she doesn't want her last name used) had already resolved to not have
a C-section, even though the doctor told her it was absolutely necessary.
She wasn't going to be opened up surgically, no matter what her doctor said,
no matter what any doctor said.
In some online communities, Aneka is a hero who defied the obstetrical
establishment and gave birth her way. To many doctors, however, she's a risk
-taker who put her and her baby in peril by giving birth at home.
'No, no, no, you can't do this'
Aneka's story begins nine years ago with the birth of her first daughter,
Nya. After 10 hours of labor, her doctor told her she wasn't progressing
quickly enough, and she needed a C-section.
"I didn't know any better, so I said OK," Aneka says.
In a postpartum visit six weeks later, the doctor told her she'd needed the
surgery because her hips were too small to pass the baby.
"I thought to myself, what's she talking about, I don't have small hips,"
Aneka remembers.
Four years later, doctors told Aneka she couldn't deliver her second child
vaginally, since Nya had been delivered by C-section. Studies show when a
woman gives birth vaginally after having had a previous C-section, there's a
higher chance her uterus will rupture since she's pushing against scar
tissue.
Then again, when Aneka was pregnant with her third child, son Adasjan, she
had a C-section for the same reason.
When she became pregnant with her fourth child, a boy named Annan Ni'em, she
expected to have a fourth C-section. But about seven months into her
pregnancy, Aneka started to read more about childbirth online, and noticed a
documentary by actress Ricki Lake called "The Business of Being Born," a
film released in 2008 that questions the way American women have babies.
"I was a little bit angry after watching documentary," she said. "It made me
realize I'd been robbed of the birthing experience. If possible, all women
should be allowed to birth naturally."
"I asked my doctor if I could try delivering vaginally, and she said no,"
Aneka says. "I called the hospital and they said they wouldn't allow it, and
I called three other hospitals and they wouldn't let me deliver vaginally,
either."
The closest hospital that would let her try to deliver vaginally was in
Manassas, Virginia, about 90 minutes from her Maryland home. She and her
husband, Al, decided that was too far.
So just seven weeks away from her December 1 due date, Aneka contacted the
International Cesarean Awareness Network, an advocacy group that promotes
vaginal births after cesareans, or VBACs.
"She asked me if I could find someone who would deliver her vaginally,"
remembers Bobbie Humphrey, who works with ICAN. "She started to cry because
she'd heard 'no, no, no you can't do this' so many times."
But Humphrey told her yes, that she knew of a midwife who would be willing
to deliver her baby at home.
An article in Midwifery Today, written by Barbara Stratton, the National
VBAC ban chair for ICAN, lists several approaches women have used to protest
a VBAC denial.
On December 5, three days after the C-section that never took place, Annan
Ni'em was born at home. He weighed 9 pounds, 6 ounces and was delivered
after 20 hours of labor, and, she says, just four minutes of pushing. He was
completely healthy.
"We were all crying at the delivery," says Humphrey, a doula who assisted
the midwife at the birth. "It was very emotional. I was just so proud of
Aneka."
Soon, word spread on e-mail lists and chat rooms about the healthy delivery.
"People were e-mailing Aneka saying 'congratulations, you're a role model,"
Humphrey says.
"Potential for catastrophe"
Vaginal births after cesarean sections pose some risk, but so does having
another cesarean. After weighing the risks of each, the American College of
Obstetricians and Gynecologists came out with a statement earlier this year
saying it's reasonable to consider allowing women who've had two C-sections
to try to have a vaginal delivery.
The group added that there's limited data about what should happen with
women, like Aneka, who've had more than one previous cesarean.
Despite the ACOG statement, many doctors and hospitals refuse to do VBACs
because of the risk. Women who try to deliver vaginally after cesarean have
between a 0.5 percent and a 0.9 percent chance of having a uterine rupture -
- a potentially deadly complication for both mother and baby, according to
the American College of Obstetricians and Gynecologists.
Women with two previous C-sections have a 1 percent to 3.7 percent risk of a
uterine rupture, according to ACOG.
Studies show the risk for a uterine rupture goes up if the woman's labor is
induced. Aneka's was not.
Dr. Jeffrey Ecker, a spokesman for ACOG and director of obstetrical clinical
research and quality assurance at Massachusetts General Hospital, warns
against reaching too many conclusions from Aneka's successful VBAC at home.
"Anecdote is no way for folks to make plans," he says. "Just because
something turned out well for one patient doesn't mean there are no risks
and it will turn out well for you."
He says there's a reason that uterine rupture is more likely when a woman's
had a C-section.
"You cut into the muscle of the uterus during a cesarean, and it heals with
a scar that is often weaker than the muscle that was there before surgery,"
he says. "The scar can be weak enough that the contractions cause it to
separate."
In that case, blood flow to the placenta can be interrupted, and the baby
doesn't get enough oxygen.
In its latest position paper, ACOG recommended that VBACs be attempted "in
facilities with staff immediately available to provide emergency care."
"There is potential for catastrophe if [a uterine rupture] happens in a home
environment," says Dr. William Grobman, an ACOG spokesman and associate
professor in the Department of Obstetrics and Gynecology at the Feinberg
School of Medicine at Northwestern University.
Grobman says he understands Aneka's desire not to have another C-section.
"This was a last resort. This was a choice because she had no other options,
" he says.
But Aneka says if she has another child, she'll give birth at home.
"Once you have that experience there's no other way to go, being in the
comfort of your home without any unnecessary interventions and feeling like
you're in charge," she says.
the phone rang.
It was her obstetrician wanting to know where the heck she was. Did Aneka
forget that today was the day for her cesarean section? How could she have
forgotten?
No, Aneka hadn't forgotten. She hadn't shown up intentionally.
"She told me, 'You're being irresponsible. Your baby could die. You could
die,'" Aneka recalls. Then the doctor hung up.
Aneka (she doesn't want her last name used) had already resolved to not have
a C-section, even though the doctor told her it was absolutely necessary.
She wasn't going to be opened up surgically, no matter what her doctor said,
no matter what any doctor said.
In some online communities, Aneka is a hero who defied the obstetrical
establishment and gave birth her way. To many doctors, however, she's a risk
-taker who put her and her baby in peril by giving birth at home.
'No, no, no, you can't do this'
Aneka's story begins nine years ago with the birth of her first daughter,
Nya. After 10 hours of labor, her doctor told her she wasn't progressing
quickly enough, and she needed a C-section.
"I didn't know any better, so I said OK," Aneka says.
In a postpartum visit six weeks later, the doctor told her she'd needed the
surgery because her hips were too small to pass the baby.
"I thought to myself, what's she talking about, I don't have small hips,"
Aneka remembers.
Four years later, doctors told Aneka she couldn't deliver her second child
vaginally, since Nya had been delivered by C-section. Studies show when a
woman gives birth vaginally after having had a previous C-section, there's a
higher chance her uterus will rupture since she's pushing against scar
tissue.
Then again, when Aneka was pregnant with her third child, son Adasjan, she
had a C-section for the same reason.
When she became pregnant with her fourth child, a boy named Annan Ni'em, she
expected to have a fourth C-section. But about seven months into her
pregnancy, Aneka started to read more about childbirth online, and noticed a
documentary by actress Ricki Lake called "The Business of Being Born," a
film released in 2008 that questions the way American women have babies.
"I was a little bit angry after watching documentary," she said. "It made me
realize I'd been robbed of the birthing experience. If possible, all women
should be allowed to birth naturally."
"I asked my doctor if I could try delivering vaginally, and she said no,"
Aneka says. "I called the hospital and they said they wouldn't allow it, and
I called three other hospitals and they wouldn't let me deliver vaginally,
either."
The closest hospital that would let her try to deliver vaginally was in
Manassas, Virginia, about 90 minutes from her Maryland home. She and her
husband, Al, decided that was too far.
So just seven weeks away from her December 1 due date, Aneka contacted the
International Cesarean Awareness Network, an advocacy group that promotes
vaginal births after cesareans, or VBACs.
"She asked me if I could find someone who would deliver her vaginally,"
remembers Bobbie Humphrey, who works with ICAN. "She started to cry because
she'd heard 'no, no, no you can't do this' so many times."
But Humphrey told her yes, that she knew of a midwife who would be willing
to deliver her baby at home.
An article in Midwifery Today, written by Barbara Stratton, the National
VBAC ban chair for ICAN, lists several approaches women have used to protest
a VBAC denial.
On December 5, three days after the C-section that never took place, Annan
Ni'em was born at home. He weighed 9 pounds, 6 ounces and was delivered
after 20 hours of labor, and, she says, just four minutes of pushing. He was
completely healthy.
"We were all crying at the delivery," says Humphrey, a doula who assisted
the midwife at the birth. "It was very emotional. I was just so proud of
Aneka."
Soon, word spread on e-mail lists and chat rooms about the healthy delivery.
"People were e-mailing Aneka saying 'congratulations, you're a role model,"
Humphrey says.
"Potential for catastrophe"
Vaginal births after cesarean sections pose some risk, but so does having
another cesarean. After weighing the risks of each, the American College of
Obstetricians and Gynecologists came out with a statement earlier this year
saying it's reasonable to consider allowing women who've had two C-sections
to try to have a vaginal delivery.
The group added that there's limited data about what should happen with
women, like Aneka, who've had more than one previous cesarean.
Despite the ACOG statement, many doctors and hospitals refuse to do VBACs
because of the risk. Women who try to deliver vaginally after cesarean have
between a 0.5 percent and a 0.9 percent chance of having a uterine rupture -
- a potentially deadly complication for both mother and baby, according to
the American College of Obstetricians and Gynecologists.
Women with two previous C-sections have a 1 percent to 3.7 percent risk of a
uterine rupture, according to ACOG.
Studies show the risk for a uterine rupture goes up if the woman's labor is
induced. Aneka's was not.
Dr. Jeffrey Ecker, a spokesman for ACOG and director of obstetrical clinical
research and quality assurance at Massachusetts General Hospital, warns
against reaching too many conclusions from Aneka's successful VBAC at home.
"Anecdote is no way for folks to make plans," he says. "Just because
something turned out well for one patient doesn't mean there are no risks
and it will turn out well for you."
He says there's a reason that uterine rupture is more likely when a woman's
had a C-section.
"You cut into the muscle of the uterus during a cesarean, and it heals with
a scar that is often weaker than the muscle that was there before surgery,"
he says. "The scar can be weak enough that the contractions cause it to
separate."
In that case, blood flow to the placenta can be interrupted, and the baby
doesn't get enough oxygen.
In its latest position paper, ACOG recommended that VBACs be attempted "in
facilities with staff immediately available to provide emergency care."
"There is potential for catastrophe if [a uterine rupture] happens in a home
environment," says Dr. William Grobman, an ACOG spokesman and associate
professor in the Department of Obstetrics and Gynecology at the Feinberg
School of Medicine at Northwestern University.
Grobman says he understands Aneka's desire not to have another C-section.
"This was a last resort. This was a choice because she had no other options,
" he says.
But Aneka says if she has another child, she'll give birth at home.
"Once you have that experience there's no other way to go, being in the
comfort of your home without any unnecessary interventions and feeling like
you're in charge," she says.
