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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 Janell d Johnosn on August 8, 2009 at 6:53am
yes i am and we are so happy and even with 3 premature babies they are as healthy as any child can be and born at 32 weeks each one only stayed in the hospital 1 week and no health problems so i have to say i am the luckiest woman in the world when it comes to my babies
Comment by Bonnie P on August 7, 2009 at 9:44pm
Janell - that sounds so horrific! Are you pregnant now? If so I really hope you get the birth you want with no complications this time! It's so unfortunate when things go wrong at time when it should be the most magical moments of our lives! Best of luck to you.
Comment by Janell d Johnosn on August 7, 2009 at 6:58pm
the after birth got stuck at the scar site and had to be removed by hand it is so painful makes me want to rethink the whole no med thing they had to knock me out after just because i was in so much pain but i have had one i think every way one with meds, one with half my body numb, one with no meds, C-section now that was BAD i had a doctor who has done three at the time and left a towel in so while my son was in the NICU i was in a hospital two away for two weeks with my tummy cut open and left that way to heal from the inside out after the last one the one i was saying the after birth problem i got a clot and infection from that spent two weeks with that one and on lovenox with this one anyone need help i and a weird person so my doc tells me
Comment by Jen Bauer on August 7, 2009 at 6:36pm
What do you mean, Janell? Did you have a VBAC not go so well?
Comment by Janell d Johnosn on August 7, 2009 at 4:54pm
i am a return VBAC i have had one with some painful after effects
Comment by Cherry Tree Lane on August 5, 2009 at 3:30pm
so glad to be here and learn more about VBAC's!
Comment by Ricki Lake & Abby Epstein on August 3, 2009 at 12:29pm
As many of you know we have been working on a follow up film to The Business of Being Born, to be released this fall. We are deep into the editing now and are hoping some of you might help us out by sharing your personal birth footage and photos. Specifically, we are looking for:
1. Homebirth video footage
2. Birth video footage from anyone who had a VBAC.
3. Video of a sonogram
4. Photos of women recovering post-birth, looking especially unhappy or suffering.
5. Video footage of a free-standing birth center (exterior & interior)
If you have any of the below materials and would be willing to let us use them in the film, please fill out and sign the attached release form and mail us your footage by August 15, 2009 on DVD, mini DV, DVCam or any format you have, to the address below. Please do not send us your only copy as we will not be able to return the copy you send us. If you have photos (for item #4) or any questions you can email us at info@mybestbirth.com.

Mail footage with a brief description and the release form to:

Amy Slotnick
Business of Birth
15 W 11th St #3A
NY, NY 10011

Please note we will blur out faces of any doctors, birth attendants or people in the footage from whom we do not have approval.

Thanks for your help!

Warmly, Ricki & Abby
Comment by Cherylyn on July 29, 2009 at 10:18am
I just had my first home birth about 2 weeks ago, and I'm so glad I had him at home. He was a surprise breech, and I feel if I'd been in the hospital they would have wanted to do a c-section. I agree with Michelle about home birth, that you need to know what you want and why you want it, and you need to be confident in your decisions. I felt a great deal of peace about my decision to have my baby at home, and that peace stayed with me throughout my pregnancy and gave me the confidence I needed to follow through. I also agree that it's important to have a good strong support team. My support team was my husband, my midwife and her attendants, and they were all awesome.
Comment by Michelle Van Norman on July 29, 2009 at 10:03am
Brandi. I had 2 c-sections before i had my home water birth. My second son spent 3 weeks in the nicu because of his repeat c-section and i swore i would never deliver in a hospital again. I started alot of research on my own after my first son's c-section. Then i found an amazing midwife before i got pregnant with my daughter. I will tell you one thing birthing at home or doing a natural birth is alot of mental work. You need to make sure that in your mind that this is what you want and there is no other option. Otherwise it wont work. I knew i would never have another c-section so delivering at home was my only option. Also have a support group to fall back on. My husband and sister were amazing never did they think i was crazy they both knew why and understood. My sister actually was my son''s second mom when he was in the nicu because i was at a different hospital recovering she would go and check on him and send me pictures and updates every morning. So she knew what i was avoiding. And she actually just had her first daughter on monday and invited me to be there. Of coarse she thought my daughters birth was beautiful she wanted drugs and to be induced. Unfortunatly after 15hrs the hospital said she had to have a csection. it broke my heart to see them wheel her away with tears in her eyes because she didnt want one. Her husband looked defeated. It was just another reminder why i stay away from those places when i want to deliver a baby. Good luck and dont listen if someone says you cant do it because you can.
Comment by Deep South Doula on July 9, 2009 at 8:17am
VBA2C...That's where I stand. Searching for any experience, advice, research, websites where I can find good, current, correct information to present to OBs that I am currently interviewing. I'm not pregnant yet and am in the the process of finding a doctor in my hometown so I don't have to drive 45 minutes for appts and to deliver. I'm working toward starting an ICAN chapter in North Louisiana and I'm hoping that will aid in my efforts. Any other info or advice would be much appreciated!

Namaste'
 

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