Moms who have had or are interested in knowing about VBACs - Vaginal Birth After Cesarean

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Latest Activity: Dec 3, 2013

VBAC Article from TIME Magazine

Read Pamela Paul's fantastic article for Time Magazine: The Trouble with Repeat Cesareans.

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

VBAC preparation

Started by Nicole A. Tucker, Lic. LCC Jun 26, 2013. 0 Replies

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

Comment Wall


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Comment by Person on December 3, 2013 at 11:19am

Unfortunately Santa Barbara hospitals do not allow VBACs. I am currently in a dispute with my health care provider to allow me to leave the area and drive over 100 miles to the nearest hospital that will allow a VBAC. 

I am hopeful! 

Comment by Nicole A. Tucker, Lic. LCC on February 21, 2013 at 5:24pm

It's possible to prepare your body in advance for a VBAC.  I recommend natural and non-invasive health options as these are most gentle and safe on your body.  Feel free to look into the services of my practice.

Comment by Yvonne p on February 21, 2013 at 11:04am

..oh and I also got cut open like a butcher with a classical c-section (verses the more common lower transverse incision)  DON'T EVER LET A DOCTOR TALK YOU INTO A CLASSICAL C-SECTION it then makes you more susceptable to uterine rupture and miscarrage of course something I learned after the fact.  I am now a birth Doula and I hope I can stop the abuse of women in child birth.

Comment by Yvonne p on February 21, 2013 at 11:00am

I also had a c-section with my first daughter who was also footling breech.  I then two years later had a wonderful natural vaginal hospital birth (I really wanted a home birth but was discouraged from even having a vaginal birth).  In Canada its much like the US they encourage you to have more c-sections but its like being hit by a bus for three months verses feeling like you ran the most wonderful marathon in the world and won.  Three days after my second daughter I went for a jog and felt fantastic only days verses months afterwards with no Tylenol 3 needed.  Believe in your ability to birth and drink lots of water 2L per day.  It was the best decision I have ever made.  I also felt better about myself after although the nurses in the hospital after my c-section were very mean and abusive when it came to wanting to breast feed and handing out tylenol for pain.

I wish all the best and take care :)

Yvonne Potter

Comment by patricia hudy on January 30, 2013 at 12:30pm

Looking to have a natural VBAC. Not currently pregnant but we are trying. If you have info for the Milwaukee, Wi. area please let me know.

Comment by Martina Speirs on February 1, 2012 at 5:33am

Thanks!  I'll check it out!!

Comment by Marci For Birth Choice on February 1, 2012 at 1:40am

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

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.

Comment by Martina Speirs on December 13, 2011 at 10:56am

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.

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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