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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 Brittany Tubb on September 21, 2009 at 1:45pm
my first doctors visit is on friday!! i can't wait!! :))
Comment by Bonnie P on September 21, 2009 at 1:44pm
Thanks Cherylyn, lots of resources there!
Comment by Jennifer C on September 20, 2009 at 3:33pm
I wanted to share this site with everyone. www.birthcut.com Fabulous!
Comment by Cherylyn on September 20, 2009 at 10:51am
I just found a great blog post about VBAC resources and wanted to share with all of you wonderful ladies!

VBAC, HBAC & VBAMC Resources
Comment by Marinda Lloyd CD, HCHI, LE, HBE on September 19, 2009 at 10:49pm
hey ladies. I am new at this posting stuff. But I just wanted to say that we just found out we are expecting #2, and planning a VBAC. It is so great to see these stories and inspiring words.
Comment by Bonnie P on September 19, 2009 at 10:28pm
Way to go, Cindy! I love hearing success stories!
Comment by Cherylyn on September 19, 2009 at 3:40pm
That's AWESOME! Congratulations!
Comment by Kaisha on September 17, 2009 at 11:49pm
Right now I'm 33 weeks. I'm hoping my uterus is growing lots and that at the next check my placenta is far away from my cervix!
Comment by Ashley Wegner on September 17, 2009 at 7:04pm
Kaisha - How far along are you? You may have plenty of time for the baby to move or even find a new doc if it comes down to that.
Comment by Kaisha on September 17, 2009 at 3:30pm
Hi Ladies,
Planning a VBAC for this birth. Had a c/s with my son in 2007 due to fetal distress, failure to progress, etc. After 26 hours of labor I was only 7cm, he had mec in his water when they broke it, I had a temp that wouldn't go down, and his heart rate was showing unreassuring heart tones. So they decided it was time for him to get out. I'm a pretty little person, 5 feet 2 inches and non preggo about 100 pounds and he was 8 pounds 8 ounces. He was also posterior asyphalic. This baby is posterior right now too, hoping he moves. My placenta is also low but NOT near my scar, on the opposite side but only 1.7cm away from my cervix. I have a u/s scheduled in 2 weeks to see if it has moved farther away. My doctor doesn't want me to do a VBAC if it isn't at least 4 cm away from my cervix. So we'll see!
 

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