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 leah walz on May 28, 2009 at 10:02am
I have had 4 c-section. Have always wanted a home birth. I had my first c because my son was breech. They tried to turn him but he wouldn't. My doc had told me I have a small pelvis so I just figured I was meant to give birth. I have never gone into labor. He told me I could probably birth a baby no more then 6 1/2 lbs. My smallest was 7lbs 13 oz. Hubby is scared to have a home birth. Not sure I can find a midwife willing to help me or if it's safe to try. My doc did tell me when I had my last section 16 mos ago that I have healed very good with all my others. Very little scar tissue for have that many sections. There are no in my are willing to do this that I know of. not really wanting to go down that road really either. So just kinda wonder if anyone would be willing to try this if the were in my shoes. I believe I can do this it's just finding someone to help me!
Comment by Trish Baxter on May 27, 2009 at 7:52pm
I just found when I had my c-section 2 years ago both of my cuts are horizontal, which are the better kind to have for going vbac. so my doctor says she does not see why I can't try doing the vbac. So i am keeping my fingers crossed that she lets me...
Comment by Denise on May 27, 2009 at 6:38pm
How do go about obtaining the hospital protocols for VBACs?
Comment by Kimberly James on May 26, 2009 at 11:20am
Gina, yeah isn't that brilliant! Timely too since I'm looking at consent forms and birth plans these days.

Ashley, I strongly recommend a doula who has a lot of experience guiding VBACs. And your husband really needs to work on his own fear too. I'm also thinking about ordering the Hypnobabies home study program. They have an extra CD just for VBAC mamas!
I also recommend getting as much info as you can regarding hospital protocols for VBAC, any consent forms they would have you sign, and asking your caregiver about his/her protocol. )))HUGS!(((

I'll be blogging about some of this pretty soon... at Trial of Labor
Comment by Gina Crosley-Corcoran on May 26, 2009 at 11:17am
Ashley, I felt all the nerves you did before my VBAC, but I finally hired a doula at 37 wks pregnant and armed myself with a ton of information. Has your husband seen BoBB? That's what did it for my husband. After that, he knew what we'd be up against and he knew how to recognize the "cascade of interventions" and the scare tactics. It was a heck of a fight, but I got my VBAC, and it was the most amazing experience of my entire life. Get yourself a good support team and do all your homework. I'm convinced that VBACing is all about how badly you want it. If you really want/need it, you'll make it happen.
Comment by Cherylyn on May 26, 2009 at 11:02am
Ashley, choose your birth team carefully, including your caregiver (doctor or midwife) and a birth doula if you choose to. With the right support team on your side, you can achieve anything. It will also help your husband to have other support there to help him stay strong as well as you. Write a clear birth plan, discuss it with your hubby, your caregiver, doula and the hospital where you plan to give birth, to make sure that your wishes can be honored by them. You still have plenty of time to do this, and you CAN do it :)
Comment by Ashley Wegner on May 26, 2009 at 10:44am
I'm only 5 mos. along and I'm already starting to get REALLY nervous about this impending birth. This is totally unlike me because I'm uber-laidback and I'm usually the one that is telling other people to calm down.
I want this VBAC so badly and I don't know if I can handle having another c-section, but I don't know if I'll be able to stay strong if the doctor starts pressuring me to do repeat c/s. I know if they start the scare tactics on my husband, he'll cave-in (he's already told me this). He's the strongest person that I know and if I don't have his support when I really need it, I don't know how I'll stay strong.
Comment by Gina Crosley-Corcoran on May 26, 2009 at 9:39am
For those who haven't seen it - The Consent Form for the OB to Sign
Comment by Amber Nibbelink on May 26, 2009 at 7:30am
I had cytotec used on me with my first daughter, not knowing that it wasn't approved for l&d. 45 minutes after they gave me the cytotec I had an emergency c-section. They're were extenuating circumstances since I had developed pre-eclampsia, but I would never let them give me anything unnatural again. With my second daughter I was told in order to VBAC I HAD to go into labor naturally, they would not use any kind of medical intervention to induce. I used evening primrose oil starting around 38 weeks to help soften my cervix and then my midwife told me to try blue cohosh. My midwife also stripped my membranes 3 times in the last week or so and I think that helped a little. I finally ended up taking some castor oil once I was a few days overdue. My midwife also said that even natural induction won't work if your cervix isn't ready. My daughter was born VBAC the day after I took the castor oil. I hope you can have a successful VBAC!
Comment by beebrown02 on May 26, 2009 at 6:55am
Great info at VBAC after multiple C-sections.

For anyone that has had multiple previous C-sections this is some interesting - and very positive - information!

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