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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 Kimberly James on May 24, 2009 at 7:37pm
Cherylyn, Cytotec is an ulcer medication. Here's a link to one of my brief blog posts about it - http://labortrials.wordpress.com/2008/09/08/gross-oversight-cytotec-not-on-fdas-warning-list/
Comment by Kimberly James on May 24, 2009 at 7:35pm
Christine, you might also want to look at this nurses' group discussion:
http://allnurses.com/ob-gyn-nursing/how-high-too-104586.html
Comment by Kimberly James on May 24, 2009 at 7:34pm
I touched on this in my most recent blog post - http://ow.ly/90uU

Specifically Wagner produced a table in Born In the USA which provides sample rupture rates:
1 in 33,000 – woman with unscarred uterus
1 in 200 – VBAC without augmentation or induction
1 in 100 – VBAC with oxytocin augmentation
1 in 43 – oxytocin induction
1 in 20 – Cytotec induction

I did also read somewhere that foley induction isn't terribly effective. I'd probably try it though if I were being pressured. Also, sperm has prostaglandins...

I also recommend reading this - http://www.midwiferygroup.ca/downloads/vbac/C&W%20Dept%20of%20Mwy%20VBAC%20Guideline.pdf
Comment by Errin Woodward on May 24, 2009 at 11:42am
Scary...that they use these types of things on pregnant women without even telling them. What happened to informed consent?? Or FDA approval?
Comment by Gretchen Malone on May 24, 2009 at 11:29am
Remember Cytotec is not even approved for induction. It has never been approved by the FDA as a type of induction aide. It clearly states on the warnings...Do not use with pregnant women. Cytotec is a medication used to treat Ulcers. My sister had cytotec used on her with her first...She had a vag birth...but when she was reading her records she called and asked me what Cytotec was... Totally amazing that she was neve told what she was getting and what affects it could have on her.
Comment by Errin Woodward on May 24, 2009 at 11:24am
No one has been pregnant forever...:) and back in the old days, people didn't even really know how many weeks they were - the baby came when it was ready. Your body is not broken, your baby is just not ready yet. I am a firm believer that your labor will be faster and easier when your body is ready for it. You might also want to consider natural induction methods...blue and black, etc...my midwife just told me about something she has used but I can't remember what it was. You just need someone experienced to tell you exactly what to do. Personally I try to avoid those things even though I am a 42-weeker because I just feel my body will do it better on it's own and even though it's natural it's still an induction in a sense...but in certain situations (like yours) it might be better than the alternatives.
Comment by Christine Dayton on May 24, 2009 at 8:11am
I've done some research too and would not, under any circumstance, agree to Cytotec. I would also very much stear away from Cervadil. Pitocin does also increase risks of rupture but not by nearly as much as Cytotec or Cervadil. Pitocin also has the advantage of being able to be turned off and when it is, it is very quickly out of your system so as long as you're closely monitored it can be an option for a vbac induction (according to my OB). The problem that will come up if I get to Tuesday with a Pitocin induction for me is that unless my cervix shows some good signs of being ready my doctor is not going to easily agree to it (he doesn't want to induce just to have that fail and end up in a c-section anyway). So far (as of last Monday anyway) my cervix has shown no dilation and very little effacement. My preference of course is to avoid all medical induction but at this point, unless something happens for me very very soon, I just dont see that happening. I honestly never thought I would be over 42 weeks - the idea of that never even crossed my mind. I have done all kinds of natural planning for a vbac (hired a doula, learned hypnobirthing, etc) so to be where I'm at right now is disappointing to say the least. If labor would just start I have complete confidence I could do this. It just won't start. It's really hard to avoid thinking my body is "broken" and just won't do what it needs to on its own. I don't like even saying that but must admit the thought has crossed my mind a few times in the last couple of days. Sorry to vent and sound so negative.
Comment by Cherylyn on May 24, 2009 at 7:41am
I've heard that about Cytotec, but is Cytotec a prostaglandin?
Comment by beebrown02 on May 24, 2009 at 7:13am
The research that I've done indicates that prostaglandins can be dangerous for women who have had previous c-sections. Especially Cytotec. Studies have shown that they lead to increased risk of uterine rupture. In fact, that is what lead the AMA to say that VBACs were dangerous...rather than just say that women who have had c-sections shouldn't be given prostaglandins.

Good luck talking to your doctor and I hope things get moving soon.
Comment by Errin Woodward on May 23, 2009 at 12:52pm
That's great that you have a vbac friendly doctor...they are so difficult to find these days! Hoping that things happen on their own over the weekend!
 

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