When I was pregnant and planning a vaginal birth after cesarean (VBAC), I had a friend ask me, “Why would you want to risk it?” It struck me as an odd question. Would she ask the same question if I had been planning a repeat c-section (RCS)? I think her question highlighted the mindset that most people approach birth with – one set of options is safe, and one set of options is risky. I can’t blame her for thinking that way because that’s honestly how many providers present options. We see this all the time in VBAC “consent” forms. These “consent” forms list all the risks of VBACs and all the benefits of RCS – as if RCS doesn’t have risks or as if VBAC doesn’t have medical benefits. But that’s not actually how it works.
Every option that you are presented with in pregnancy and birth has risks. You may feel safe giving birth in a hospital, but a hospital setting introduces unique risks that a homebirth does not. You may feel safe giving birth at home, but homebirth has unique risks that a hospital birth does not. You may feel that going post-term is too risky, but by taking action to avoid a post-term birth, you are trading the risks of post-term birth for the risks of induction and possibly even preterm birth. That may be a worthwhile trade for you; it’s up to you to decide.
I would like to propose a new way to think about decisions in pregnancy and birth. Think about your decisions as trading risks. There is no such thing as a risk-free birth. With every decision you make, you are accepting a certain set of risks. Here are some examples:
I want to avoid the risks of pre-eclampsia by accepting the risks of induction.
I want to avoid the risks of VBAC by accepting the risks of an RCS.
I want to avoid the risks of unmanaged gestational diabetes by accepting the risks of testing and/or treatment.
Hopefully this reframing will help you identify the risks that you are accepting with every decision that is made. Because every decision means that you are accepting risks. It’s important to know what risks you’re saying “yes” to every time you decide to say “no” to the alternative choice.