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VBAC Moms

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

Members: 224
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

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Comment by Cherylyn on May 16, 2009 at 9:18am
Efrat, I really appreciate your story. I'm so happy for you and your son that you've been able to breastfeed successfully. Breastfeeding can be hard work, but if you keep at it, like you did, then it is definitely rewarding.

Kimberly, thank you for your story as well. I'm glad to hear that there are cases with c-section in which the baby is able to breastfeed soon after birth, and I wouldn't be surprised if the labor in the birth canal helped her as well. Good stuff!
Comment by Kimberly James on May 16, 2009 at 8:59am
I had a great nursing relationship with my DD even though I ended up with a c/s. Perhaps the fact that I labored and pushed helped. I was also able to start getting her latched on in recovery. The experts do say that the 1st two hours are the most crucial for nursing/bonding.

Efrat, that's a wonderful success story!!
Comment by efrat on May 15, 2009 at 7:48am
last year, i had an unplanned c-section. even though i read only natural-birth leaning material, took a bradley class, and labored for 24+ hours unmedicated, my water was full of meconium when they finally broke it after 4 hours of pushing. my son was delivered by c-section and ended up spending 13 days in the NICU. we weren't allowed to hold him until he was 5 or 6 days old. i pumped from day one and they made sure to feed him my colostrom & milk (though he only got IV fluids for his first days). i was allowed to try to nurse him when he was 6 days old. i was so relieved when he latched on!

so, after reading all the other c-section/nursing stories here, i feel very lucky to report that my son is 13 months old and we're still nursing. we've had a few issues along the way, but we stuck with it and i feel very blessed that we are where we are. having said all this, i fully agree that a c-section and the separation from baby that goes along with it are POOR conditions to set up a good nursing relationship.
Comment by Cherylyn on May 15, 2009 at 5:45am
I definitely think it has to do with how soon you get the baby latched on after birth. The ideal time to establish breastfeeding is within the first two hours after birth, but with a c-section that rarely happens because of all of the surgical stuff and anesthesia, etc. The other thing is that when a baby goes through the birthing canal it actually prepares its lungs for proper breathing, which helps with breastfeeding. In a c-section, the baby hasn't had the preparation in the birth canal and may have more breathing distress and/or trouble latching on.
Comment by shayne on May 15, 2009 at 4:05am
I had a c/s with my first. She was unable to latch and my milk never came in. I pumped night and day for a month trying to increase my supply. I could only get at once or two at a time and it eventually just dried up.
I do think the c/s may have been partly to blame. I was allowed to labor for 17 hours and I pushed for three. She was in distress and she wouldn't buge. So, I don't feel like i was 'pushed' into a c/s. Also, she was a month early and I have large, flat nipples. Also, the pediatrician said she would be fine for 24-48 hours as I tried to breast feed. But, the nurses insisted on giving her formula the first day, because she 'needed' it.
So, all and all, I can't totally blame the c/s for my inability to breast feed, but it did play a role..
I'm due in August with my second and plan to try for a VBAC. I am more determined to breast feed this time, and my baby will not be leaving my side! Wish me luck! xoxo- shayne
Comment by vanessa belling ducos on May 14, 2009 at 6:22pm
i was to out of it when i got my c/s thay put me out did not get to feed my girl for 3 howers then had problems coming in
no prob with my first that i had vag way
Comment by irene cockerham on May 14, 2009 at 6:09pm
I had to suplement alot of formula. I had problems breastfeeding from the beginning.
Comment by Ashley Wegner on May 14, 2009 at 3:49pm
I'd have to say that I agree w/ the breastfeeding and c/s discussion. I had the same experience, my poor son had a terrible time latching on and I wound up only being able to breastfeed for 3 months because I believe that I wasn't able to establish a good supply. My supply actually decreased as he got bigger.
I went on prenatal vitamins while I was trying to get pg w/ #1 and this baby. The first time my doctor prescribed me some when I told her we were trying to get pg and also had me take folic acid. The second and third time I just went and picked some up from the drug store I think it really helps.
Comment by Eileen Breeze on May 14, 2009 at 1:30pm
Re: breastfeeding and c/s...I am absolutely convinced that having a c/s effects our ability to nurse. My son (now 3.5) was a c/s, and we had a great deal of difficulty latching and nursing. I ended up w/ a nasty case of mastitis at 1 wk pp, though at the time I think I was more worried about my incision being infected. (the incision opened a "little" bit and leaked this weird yellow fluid, which my OB told me was nothing to worry about. Still, it was frightening.) I pushed through it b/c at the time I think I needed to "do something right" (labor and c/s felt very medical and very out of my hands, though I sensed that it shouldn't be that way). I ended up nursing my son for 7.5 months. But basically - the MAJORITY of my girlfriends have had c/s - and the majority of that number have had trouble breastfeeding, likely from the pain and worry over the incision and an inability to really "get comfortable" while holding a squirmy infant!

And Lyssa - your body is strong!! Be patient with the scar - it WILL heal. Though I didn't have an infection in my incision, it did take us about 14 mos to concieve this time. I was terrified that the c/s had caused some irreversible issue, but I'm now 33 weeks along w/ #2 - and planning/prepping for my VBAC! I also took herbs - black cohosh from cycel day 1 - until ovulation to boost my estrogen levels and improve my "ovulation quality." B.C. shouldn't be taken in the 2nd half of the cycle as it can cause uterine cramping. It worked right away for both of my pregnancies, which I still can't believe, as I am not big on the herbs. But ALL will be well! Trust yourself!!
Comment by Lyssa McConathy on May 13, 2009 at 2:59pm
thanks for the encouragement, Krista. that's great that you don't have much of a scar now -- I always refer to mine as my "Freddy Krueger" scar; it's pretty bad, but I think it is because of the infection afterwards.

I am definitely hoping & praying that we are able to conceive again, first off, and that I can go on to have a VBAC successfully. Hopefully my first c-section will be my last :-)
 

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