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Moms who have had or are interested in knowing about VBACs - Vaginal Birth After Cesarean
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VBAC Article from TIME Magazine
For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can’t find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he’s not on call the day she goes into labor? That’s why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. “One of my biggest worries is the 100-mile drive to the hospital,” she says. “It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car.”
Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that “once a cesarean, always a cesarean”–an axiom thought to be outmoded in the 1990s–is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don’t allow VBACs, up from 10% in its previous survey, in 2004. ICAN’s latest findings note that another 21% of hospitals have what it calls “de facto bans,” i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them.
Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real–and can be fatal to both mom and baby–but rupture occurs in just 0.7% of cases. That’s not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.
After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall–even though 73% of women who go this route successfully deliver without needing an emergency cesarean.
So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be “readily available” during a VBAC to “immediately available.” “Our goal wasn’t to narrow the scope of patients who would be eligible, but to make it safe,” says Dr. Carolyn Zelop, co-author of ACOG’s most recent VBAC guidelines.
But many interpreted the revision to mean that surgical staff must be present the entire time a VBAC patient is in labor. While major medical centers and hospitals with residents are staffed to provide this level of round-the-clock care, smaller hospitals typically rely on anesthesiologists on call. Among obstetricians, many solo practitioners are unable to stay for what could end up being a 24-hour delivery; others calculate the loss of unseen patients during that time and instead opt to do hour-long cesareans, which are now the most commonly performed surgeries on women in the U.S.
Some doctors, however, argue that any facility ill equipped for VBACs shouldn’t do labor and delivery at all. “How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?” asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH’s largest prospective VBAC study.
Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. “It’s a numbers thing,” says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. “You don’t get sued for doing a C-section. You get sued for not doing a C-section.”
Of course, the alternative to a VBAC isn’t risk-free either. With each repeat cesarean, a mother’s risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman’s chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta–in which the placenta attaches abnormally to the uterine wall–has increased thirtyfold in the past 30 years. “The problem is only beginning to mushroom,” says ACOG’s Zelop.
“The decline in VBACs is driven both by patient preference and by provider preference,” says Dr. Hyagriv Simhan, medical director of the maternal-fetal-medicine department of Magee-Womens Hospital of the University of Pittsburgh Medical Center. But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won’t allow the procedure, is concerned that women are getting “skewed” information about the risks of a VBAC “that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision.” According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.
Zelop is among those who worry that “the pendulum has swung too far the other way,” but, she says, “I don’t know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid.” So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: “When the problems with multiple C-sections start to mount, we’re going to look back and say, ‘Oh, does anyone still know how to do VBAC?’”
Discussion Forum
EPO/Borage oil = same as Prostaglandin induction?
Started by Marci For Birth Choice. Last reply by Marci For Birth Choice Dec 27, 2011. 2 Replies 0 Likes
Posterior baby with previous labour (c-section) gives lowest percentage of sucess in VBAC?
Started by Kim. Last reply by Marci For Birth Choice Oct 23, 2011. 5 Replies 0 Likes
Compilation Of VBAC and Cesarean Birth Stories
Started by Ashley Love. Last reply by Erin Jul 8, 2011. 1 Reply 1 Like
Comment Wall
Comment
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Comment by Martina Speirs on Wednesday
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Thanks! I'll check it out!!
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Comment by Marci For Birth Choice on Wednesday -
Hey Martina,
There's a story of a woman who had an HBAC on the homepage for this site. Inspiring! Good luck with your choice
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Comment by T. Hill on December 24, 2011 at 4:35pm -
To Yvonne P, thank you for your post. I'm happy to see a positive vbac after a classical c-section.
I had a c-section at 30 weeks due to premature labor and my son was footling breech. Upon going in, my uterus supposedly wasn't developed enough for a low transverse so they did a classical. I didn't know until I was in recovery. That was almost 5 years ago..
I just found out I'm pregnant again and I've had plenty of time to reflect on why my last pregnancy ended up the way it did. I'm in a much better place, physically and mentally and there's no reason why I can't carry to term this time. Thankfully, I found a midwife who's willing to attend my birth.
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Has anyone had an HBAC? I was really hoping to at least consider having this third baby at home, but my husband is adament that he will not allow it. I have already had one successful VBAC (and laboured at home until transition so went very smoothly) and have so much faith that home is where I want to be, but he just thinks it's way too risky. Was hoping to hear from anyone who has had a HBAC.
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Comment by Debra Duncan on December 3, 2011 at 1:14pm -
When I found out I was pregnant earlier this year I was excited to be planning a hbac. Then I went for my 19 week ultrasound and found out to my surprise I was carrying identical twin boys that shared a placenta. My midwives said it was out of their scope so I had to have shared care with a perinatologist, which of course meant a hospital birth. So on December 19th, much to my dislike I was asked to go to the hospital for induction because repeat ultrasounds were supposedly showing decreasing amniotic fluid. The peri broke the waters of Twin A and I refused the pitocin which she wanted to administer. 5 hours later I was holding my beautiful boys, Twin A weighing 7lbs and Twin B 6lbs 3oz. It was not a perfect birth with the interventions and such, but I am so happy to have had my VBAC and two beautiful healthy boys.
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Comment by Carmen Malcolm on November 16, 2011 at 10:18am
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Hi ladies! I am new to the group! I am a natural birth and parenting blogger and I need some NATURAL mama followers. It seems that everyone who follows is not exactly my target audience.
I am also planning to do a series of POSITIVE natural birth stories to show women how awesome childbirth really can be! If you would like to share your story please let me know!
Thank you so much!
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Comment by Yvonne p on September 1, 2011 at 6:31pm
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I was able to VBAC after a Classical c-section (the most risky type of abdominal sectioning; lower T incision) due to my good health. The reason for the c-section was a breech postion; was it over kill perhaps but it left me with little options for a VBAC.
At one point I had decided if I couldn't find a practitioner that would allow me to birth naturally (given that there was no complications with my pregnancy) I would just stay home with my mother and sister at my side (who are seasoned birth doulas that have also had home births themselfs.
I feel that the research data outthere are inacuarate and don't properly identify things that increase risk of rupture. In Veterinary medicine there are quite a few very good studies (statisically accurate) that identify risk factors that may increase your risk of rupture. These factors have not been studied in humans and many studies contain to many variances to accurately identify risks.
Personally I feel if you are a healthy individual and take steps homeopathically to improve your chances of natural birth the outcomes are very good. Chiropractors, rasberry leaf tea and meditation helped me to reach my goal;
And I am forever grateful for the OBGYN that made it possible it has changed me forever; my body, my birth, my choice!
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Comment by Makini Duewa on October 1, 2010 at 12:12am -
Greetings Mamas & VBACtivists!
Just wanted to share a study that my colleague and I working on. We hope that with your help and thoughts we will be able to teach care providers and birth educators how to truly support the VBACing woman!
We are writing to request your assistance with a project. We are conducting a survey around Vaginal Birth after Cesarean (VBAC). THE SURVEY IS ATTACHED. We need to hear the voices of women who have attempted VBAC regardless of the outcome. The information gathered will be used to assist women who are attempting VBAC to be successful in their efforts. There is often much fear and apprehension surrounding VBAC and many hospitals do not even allow attempts. The AMA (American Medical Association) and ACOG (American College of Obstetrics and Gynecologists) go back and forth on their recommendations, currently they are pro-VBAC, but still hospitals may not wish to "take the chance".
Makini and I are deeply invested in this study. We are both women who have had VBACs. I have had a Home (Vaginal) Birth after Cesarean (HBVAC or HBAC) and my dear colleague has had one Home Birth after Multiple Cesareans (HBAMC), which is an even greater feat.
We ask that you please send this survey far and wide so that we can cast a broad net. The survey is ongoing, but we need to have a large number back in the next 5-7 days. People can email their responses to Makini at makiniduewa@gmail.com.
We really appreciate this. If you are yourself a VBAC mama who is willing to complete the confidential form and mail it back, we would also love to speak with you by phone. Sincere thanks, in advance for taking the time to read this and immediately send it to some people in your address book who may be connected in this way. Please don't forget the attachment.
Much love and appreciation,
Michlene and Makini
makiniduewa@gmail.com
P.S. If you are unable to view the survey, I can email it to you directly or interview you by phone. My contact information is all listed above. Thank you so much in advance!
Makini
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Comment by Kacy Latham on May 25, 2010 at 3:18pm -
I am a mom who had an almost C-section with my first. The pitocin augmented my labor to EXTREME contractions that resulted in my son going into distress. Luckily, they checked me before they wheeled me to the OR... my son was out in 3 pushes. My second son was an induction that let to the typical chain of events and resulted in a cesarean. I just found out that I am due with baby 3 in Jan. I want to do a VBAC at home, however the closest hospital is 30 minutes away. I have a midwife and am curious if anyone has had the distance to the hospital dilemma.
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Comment by Eileen Colegrove on March 13, 2010 at 11:48am -
Just wanted to share a local article from our newspaper, it is good to see VBACs discussed and supported by some of the local doctors.
http://www.dispatch.com/live/content/local_news/stories/2010/03/11/...
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