Crystal McAuley, 34, had a simple wish for her second delivery. She wanted
to be able to pick up her 18-month-old son, Fitzgerald, when she came
home with her newborn this past February.
Because Crystal’s first delivery had been via emergency cesarean
section, she had two options this time: have a planned C-section or attempt
a vaginal birth after cesarean (VBAC). Both have risks, and the decision
wasn’t an easy one for Crystal and her husband, Simon, 42, who live
in Napa and work in the wine industry.
The primary risk with VBAC is uterine rupture, where the scar from the
prior cesarean separates; it happens in less than 1 percent of cases,
but it’s a serious complication when it does. Yet Crystal knew that
another C-section would mean a lengthy recovery, during which she wouldn’t
be able to lift anything weighing more than a few pounds, including Fitzgerald.
“I didn’t think I could go home and not pick up my son,” she says.
Susana G. Gonzalez, MD, an OB/GYN with
St. Joseph Health Medical Group in Napa, California, says she hears this motivation often, especially
since women considering VBACs likely have other children at home. “They’re
not only going to be taking care of a little newborn but perhaps a toddler
as well,” she says. The estimated recovery time for a C-section
is eight weeks; for a vaginal birth, it’s just six, because a C-section
is a surgical procedure, whereas a VBAC is not, Dr. Gonzalez explains.
(Dr. Susana Gonzalez, Crystal and baby)
Other women are motivated by the desire to experience a vaginal birth.
Not all VBAC attempts are successful, but most are. An “unsuccessful”
VBAC means the baby was ultimately delivered via C-section for any number
of reasons — not that a uterine rupture occurred. According to the
National Institutes of Health, the average success rate is 74 percent.
1 Among womenwho attempted a VBAC at the Queen in 2015, it’s 77 percent.2
THE COMPLEXITIES OF VBAC
VBACs provide a faster recovery and a reasonably high rate of success.
So why aren’t they universal?
First, it’s not possible for all deliveries. According to
R. Bruce Scarborough, MD, an OB/GYN with
St. Joseph Health Medical Group (who performed the first VBAC in Napa County), a lot depends on the circumstances
of the woman’s first C-section. If the mom didn’t dilate or
the baby’s head didn’t descend,it could be that the shape
of the pelvis wasn’t conducive to vaginal delivery. If a C-section
was necessary because of a breech position, fetal distress or something
else unrelated to anatomy, the mom is a bettercandidate for a VBAC.
The type of incision is important, too. “We don’t recommend
vaginal birth for women who’ve had vertical incisions,” Dr.
Gonzalez says. “They’ve had to have a transverse incision.”
Transverse incisions are low,horizontal incisions. They are the most common
type of incision for C-sections.
“We evaluate what their chances will be to have a vaginal birth and
counsel them in that regard,” Dr. Gonzalez says. “We want
them to go in with their eyes open and be well-informed.”
Second, not all hospitals offer VBACs. The American College of Obstetricians
and Gynecologists states that VBACs should only be attempted in facilities
equipped with a surgical team “immediately available” toprovide
emergency C-sections.3 “Many facilities can’t offer that or don’t want the liability
associated with it,” Dr. Gonzalez says. “We are very supportive
of it and we are the only hospital in the valley that will offer it. We
actually will offer [VBACs] for patients who’ve had two C-sections
in the past.”
Thirdly, some women prefer the convenience of a scheduled C-section, so
they can plan ahead for child care and time off work. “I’m
all about choices, and informing parents about what to expect,”
Dr. Scarborough says. “We do everything we can to support our mothers.”
KEEPING HER OPTIONS OPEN
Crystal’s first obstetrician was in St. Helena, but when she became
pregnant the second time, she learned they didn’t offer VBACs. So
she met with the OB team at Queen of the Valley Medical Associates (now
St. Joseph Health Medical Group). They outlined all her options and the
various considerations. They told her she didn’t have to decide
right then — or even before she began labor. “That is inevitably
why we switched practices,” she says.“We wanted to have that
And indeed, Crystal says she deliberated. “I flip-flopped back and
forth between the planned cesarean and the VBAC throughout the entire
pregnancy,” she says. “When we ended up being 10 days early
and labor was progressing naturally, that’s really when I said,
‘I want to try for it’.”
FEELING THE DIFFERENCES
Once Crystal’s active labor began, she and Simon made their way
to the Maternity Center at
Queen of the Valley Medical Center. For Simon, the hospital’s location was ideal, convenient to grocery
stores and restaurants to quickly get what he needed for Crystal or their
toddler. He also made use of the shower and the sleeper chair intheir
private room. “I managed to catch a few winks,” he says. The
couple also took advantage of the hospital Wi-Fi to stream their preferred
entertainment. “We turned the lights down in the room while I labored,
and we had music on,” Crystal says. “It was a very pleasant
After 28 hours of labor, Crystal began to feel the pressure of the baby
pushing, which she hadn’t experienced before. “With my first
one we didn’t make it that far,” she says.
Dr. Gonzalez coached her through the pushing and within a half-hour, the
McAuleys’second son, Franklin, was born.
“I could not have asked for a better scenario,” Crystal says.
“[Dr. Gonzalez’s] demeanorand the way she approached everything
was very calm and no-nonsense. She made me feelsafe and secure.”
Just hours after delivery, Crystal was stunned that she could stand up
and even take a shower. “After a C-section you cannot stand up unassisted,”
she explains. “It was the most amazing shower I’ve ever hadin
And when Crystal returned home, her wish became a reality: “I was
able to walk through my front door, pick up my son, and hold onto him
while we introduced him to the baby.”
Queen of the Valley Medical Center’s recently expanded facility offers
comfort and convenience for moms and babies. In addition to VBAC, the
center offers Certified Nurse Anesthetists available 24/7, two Operating/Cesearean
Rooms, 10 large private mother/baby suites with sleeper chairs, the opportunity
totry a Jacuzzi® birthing tub and a full-time lactation consultant.
For more information,isit thequeen.org/maternity.
2. Per Dr. Gonzalez interview.