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 Trish Baxter on May 12, 2009 at 3:10pm
Wow, Thanks everyone for you adivce I go see my doc again on the 27th of May and will be 28 weeks. so i will talk to her more about it. I am keeping my fingers crossed that she will still spport me with my decision. if not then I might try and find a midwife
Comment by Diane C. Nicholson on May 12, 2009 at 3:06pm
Trish--the whole big baby thing is a red herring. I delivered twins during my first VBAC and then a 9 1/2 boy during my second.
Comment by liz creditor on May 12, 2009 at 1:59pm
Hey Trish

The big baby dilemma. If you can move around in labor, you can get your baby out. Stay away from the hospital bed and constant monitoring. The risk of uterine scar rupture is less than 1%. I had my first vbac 3 years and 4 months after my c. And my second vbac 23 months after that with no issue. The main thing: Trust your body, get a midwife. VBAC is much safer for you and baby than a second cesearan. There are way more possible problems associated with cesarean than vbac
Good luck!
Comment by Erin Hall on May 12, 2009 at 12:54pm
Hey Trish -
It's great that you want to go for for a VBAC...It's likely there are other reasons why you never never past 2 besides the size pf your baby. Like the others said, the size of the baby is an easy excuse to tell a woman to frighten her into a repeat c-section. I would find another dr or midwife. If you have or find a dr that's overly concerned with the babies size then they are most likely not as supportive of VBACs as they might try to seem. I would contact your ICAN chapter or maybe even find a doula who knows of some supportive drs or midwives. I was told that my pelvis is extremely narrow and that i will NEVER be able to give birth vaginally...Know what I say to that? BS! I beleive that your body will not grow a baby that you cannot give birth to. I think it's just an easy excuse for drs...and it's something that we cannot easily research ourselves, as we cannot get inside our bodies to view our pelvises...and even if we could, the pelvis will open and stretch and expand to adapt to the baby coming down. Have you read "Pelvises I Have Known & Loved"...i liked it --
Comment by Krista Harris on May 12, 2009 at 12:38pm
I second everything Sandy said! Drs. love pulling the "big baby" many women have I met who've been told they are either "too small" to birth vaginally or their babies are "too big" and then go on to have beautiful natural VBACs? Tons! If you have trouble finding a midwife who attends VBACs, find your local ICAN chapter and they should be able to help you find someone local.
Comment by Sandy McCarron on May 12, 2009 at 12:05pm
Trish, I would say they are stringing you along and will tell you the baby is too big at 35 weeks and tell you to just get another c-section. By then it will seem to late to just switch providers and you'll have to go along. Around 30 weeks I started "measuring big". I said prove it and they couldn't or wouldn't. I switched to a midwife who palpated and said my son was normal size and was only off by 2oz when he was born. Please find a midwife its not too late and I think they are setting you up. You can have a nice hospital birth so you'll feel safe, but you have to fight for it. Good luck!
Comment by Trish Baxter on May 12, 2009 at 11:39am
Hi, I am 29 years old and 25 1/2 weeks pregnant with my second baby. My first was 2 years ago and was c-section because i went 12 hours after my water broke and only dialated 2 cm so for my comfort i went c-section. I kind of wish i tried going longer and gone natural. I Have talked to my doctor about going vaginal this time around and she said should be ok as long as it is not another big baby like my first baby was. (2 weeks early and weighed 8lbs 13.2oz). My doctors wants to set up a meeting at 30 weeks with the Dr. that did my c-section to see what he has to say. When i had my first baby he suggested another c-section with second baby due to the history of being big babies now. I am really hoping to go vaginal this time unless medical reasons won't let me (hurt the baby or harm me). I heard that if you are past your 2 year anniversary of the first c-section you have a better change with a vbac. I am due August , so that will put it 5 months past my 2 yr anniversary. But I am also scared, i don't want to do anything that would harm myself or my baby, or hurt my chances of another baby. As my husband and I are unsure if we would want more. I am from Ontario Canada, Anyone have any problems with vbac in Ontario in the Northumberland area?
Comment by beebrown02 on May 12, 2009 at 5:24am
I just finished reading "Your Best Birth." Wow, is all I have to say. I read it cover to cover in one sitting. So amazing. I had a c-section for my first birth and I wish this book had been around when I was pregnant with my daughter. I realize now that my fear and lack of understanding of the birth process led me to enthusically accept a c-section when it was offered to me.

Although my c-section birth was a positive experience (the hospital staff was very supportive of immediate nursing, baby rooming in etc,) I feel a little disappointed that I have jeopardized my chances of having a vaginal birth next time around.

Although I am not currently pregnant, my husband and I plan on trying again in a year or so. I feel that I will be armed with much more knowledge this time and hopefully have the best birth possible. I am due for my annual gyn appointmetn and I am now looking to switch from my large OB/GYN practice to one with midwives.

THank you for opening my eyes.
Comment by Dixon Doula on May 11, 2009 at 6:29pm
I had a c-section due to fetal distress. My second child was a VBAC. My hospital changed it's policy from being supportive of VBACs to not doing them when I was in my eighth month. With my Dr's support and a wonderful doual, I broke the hospital rules and went in anyway, refusing a 2nd c-section. I had an amazing birth experience, after 21 hours of labor (most done at home). I now work as a volunteer doual at the same hospital where I gave birth. Hands down the most powerful and amazing day in my life. Thank you to all of the midwives and doulas everywhere who recognize that birth is a life changing event, not just a medical condition.
Comment by Michelle Van Norman on May 11, 2009 at 4:49pm
I had 2 c-sections. My second son asperated blood during the c-section and spent 3 weeks in the nicu. He was on a ventilator and had 6 different chest tubes due to a hole in his lung. i didn't get to hold him for 2 weeks.I begged my dr to allow me to have a vbac and he stated that his hands were tied with the malpractice insurance. My son was released from the hospital with high blood pressure due to the iv being placed in his umbilical cord and getting to close to his kidney arteries. Before getting pregnant with my daughter i met with the most amazing midwife. She made me feel very comfortable with the decision to have a vbac at home and looked me in the eyes and told me i was not broken and i could deliver my baby my way. After getting my birth team together and having all the support i could get i went into labor. 18 hrs later Piper was welcomed into the world 5 days late. She was alert and calm. The water birth was absolutely amazing. She was 7lb's 10oz 19 3/4 in long and had a 14 in head. I had absolutely no tear and no injuries. She was healthy and so was i. I was up and taking care of her as soon as i took a little nap. She breast fed wonderfully and we have an amazing bond. I believe all of this is due to the gentle water birth in which she was welcomed into the world. I would love to do it over and over again.

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