Will VBACs make a comeback?

The New York Times wrote a fascinating story looking at the rise and fall of VBACs — or vaginal births after Caesarean section — and how the government would like to bring them back into practice more frequently. It examined the successes at a Navajo hospital in Arizona, where they have lowered their number of Cesareans and increased their number of VBACs, even though the national numbers are just the opposite.

Here is the gist of The New York Time’s very long, but very interesting, story:

In the beginning there used to be a saying “once a Caesarean, always a Caesarean.”

Doctors feared the Caesarean scars on the uterus could rupture during subsequent labors so women were always forced to have Caesareans after their first one.

However in 1980 a panel declared it was safe for many women to deliver vaginally after having a C-section and the VBAC became very popular.

By 1996 VBACs reached their high of 28.3 percent.

Then there were some problems. Ruptures, deaths and of course lawsuits lead to stricter guidelines to perform VBACs and the rate has now dropped to below 10 percent.

So why is that bad? Here’s what the New York Times’ article explains:

“The national Caesarean rate, 31.8 percent, has been rising steadily for the last 11 years and is fed by repeat patients. Critics say that doctors are performing too many Caesareans, needlessly exposing women and infants to surgical risks and running up several billion dollars a year in excess bills, precisely the kind of overuse that a health care overhaul is supposed to address.”

“Even the American College of Obstetricians and Gynecologists has acknowledged that the operation is overused. Though there is no consensus on what the rate should be, government health agencies and the World Health Organization have suggested 15 percent as a goal in low-risk women.”

“ ‘VBAC’ has become a battle cry, with fierce advocates on both sides—women who insist that they should not be forced into surgery versus doctors and hospitals who insist on repeat Caesareans, citing the risks of labor and concerns about liability and insurance. ”

With that background information, then the article looks at the Tuba City Regional Health Care Corporation. It’s a hospital run by the Navajo Nation in Arizona and many believe is a model of what obstetric care should be like across the nation.

The hospital’s overall Cesarean rate is 13.5 percent which is less than half the national rate of 31.8 percent in 2007.

And last year the hospital had 32 percent of women who previously had Cesareans deliver vaginally.  (Remember the national average is below 10 percent.)

Nurse-midwives deliver most of the babies born vaginally. It is believed that the C-section rate is lower because the midwives are trained to coach women through labor and will wait longer to recommend a C-section. Also the midwives are less likely to induce before due dates which can also lead to a C-Section.

(For comparison sake, midwives attend to only 10 percent of vaginal births nationally.)

Besides just the midwives, changes in insurance practices could also help increase VBACs, according to the article.

“Changes in malpractice insurance would also help, so that obstetricians would feel less pressure to perform Caesareans. (The hospital and doctors in Tuba City are insured by the federal government, and therefore insurance companies cannot threaten to increase their premiums or withdraw coverage if they allow vaginal births after Caesarean.) Patients, too, would have to adjust their attitudes about birth and medical care during pregnancy and labor.”

So what do you think? Did you have a VBAC? Would you have chosen a VBAC if you could? Did you feel pressured to have a C-section from your doctor or insurance company?

Do you think it is an important goal to reduce the number of C-section and increase VBACs? Would you be afraid to deliver vaginally after a C-section?

Would this story help you want to have a midwife attend your birth? Would it increase your confidence in asking for a VBAC?

243 comments Add your comment

NO, NO, NO...

March 11th, 2010
7:00 am

…and HELL, NO. As a medical malpractice claim professional with over 30 years of handling brain damaged baby cases, this is a really dumb idea. And the macho women who demand that they be allowed to deliver “naturally” only add to the problems since, even though their OB is recommending that a c-section be done, they DEMAND that they be allowed to deliver vaginally, and then blame the OB and the labor nurses when the child is compromised.

Having a mid-wife is great, until something happens; at that point the time between calling the OB, having him or her arrive, and then preparing for an emergent c-section is compromising the fetus significantly. I think there should be MORE c-sections, especially at the first sign of labor complications, rather than taking a “wait and see how the labor progresses” attitude. No telling how many lives would be saved, and how many non-compromised infants would be delivered.

Yes, the surgery is more difficult for the mother; yes, it is more expensive, initially. But, the costs of caring for brain damaged infants is quite high, too; and then the health insurance companies want the liability companies to pay that cost – this is a really good argument for there to be a brain damaged infant pool that ALL carriers contribute to so that the infants who are damaged can be cared for without concern for who or what caused the problem, especially if we can take the “macho” and “wait and see” out of the equation.

motherjanegoose

March 11th, 2010
7:07 am

NO NO NO. I had a c section my first time with my son in Texas after 14 housr of labor…he was 10 pounds 8 ounces and the cord was wrapped around his neck. No sonograms 23 years ago as the insurance was not covering them like they do now. I recovered just fine and had a healthy baby.

I feel I was part of the quota to push VBACS here in Gwinnett County, GA, when I delivered my daughter in 1992. I was in labor for 24 hours…she was 8 pounds 13 ounces ( no gestational diabetes thank you). My daughter had a birth injury called ERB’S PALSY as she was ripped out of me with the suction thing. I was ripped too. Her arm hung like a piece of wet spaghetti as the nerves were damaged from stretching her neck ( C5 and C-6) when she was rugged out of me. I had a sonogram hours before the delivery and my Doctor knew her size. I spoke with a neurologist ( at a conference) a few years back who said my delivery was botched up and they were most certainly looking for numbers to enhance VBAC quotas He was from CA and an expert in the field.

Do what you want but know that you could have a baby, perhaps delivered either way via c section or VBAC, with injuries. I cried for months for my child…had a perfect pregnancy and things got messed up by my Doctor. I requested a c section and it was approved by my insurance. She verbally told me she would let me labor for 12 hours and then see what happened….NOT.

We went thought months of agony/therapy and I had to pin her little sleeve to the front of her sleeper so it would not get twisted behind her back…. she had no feeling or range or motion whatsoever. Her baby pictures are a painful reminder.

Thankfully, she is 90% now but could never take gymnastics or be on a swim team.

Read on:

http://www.brainandspinalcord.org/cerebral-palsy/types/erbs-palsy.html

This is still a raw nerve for me….nearly 18 years later….

motherjanegoose

March 11th, 2010
7:10 am

Theresa…I posted my VBAC horror story and it has evaporated. I am off to Minnesota and cannot repost. Perhaps you can find it to give others some information about Erb’s Palsy.

I KNOW it was not as long as some others that have posted this week. What is up?

Mine did not post either...

March 11th, 2010
7:22 am

And when I reposted it said I already said that…

Dave

March 11th, 2010
7:24 am

MJG – I’ve lost several posts this week.

Mine did not post either...

March 11th, 2010
7:24 am

And when I reposted it said I already said that…

Mine did not post either...

March 11th, 2010
7:25 am

But then this shows up twice…grrrrrrrrrr

And it still will not post....

March 11th, 2010
7:27 am

shaggy

March 11th, 2010
7:28 am

In times past, the mother to be, would go into the wilderness alone, squat, and whomp there it is. If mother and child were strong enough after that ordeal, they both came back to celebration. If they didn’t, no one came looking, and the gene pool grew stronger.
Our ancestors were MUCH tougher than our wimpy society. We keep passing inferior genetics on, and future generations will pay.

But, Shaggy...

March 11th, 2010
7:30 am

…obviously you missed the point of the question – there were no c-sections in the wildnerness, and they just threw out the brain damaged kids that”whomped out”…you sir, are a moron…

Jeff

March 11th, 2010
7:30 am

I have to work on my VBAC in the gym. I don’t particularly like the lat pull down machine, but it’s the only way to reach that core muscle.

Shaggy's comment appears...

March 11th, 2010
7:31 am

…but my epistle and excellent comments will not – what is up with this site today…

Jeff

March 11th, 2010
7:31 am

But shaggy is a funny moron. I have patience for those.

And they still...

March 11th, 2010
7:33 am

…will not post, but other “junk” by me and others will…grrrrrrrr

6monthspreggo

March 11th, 2010
7:44 am

I am 6 months pregnant and I have a two year old who was born via c-section ( unplanned) He was born Christmas Eve Eve and I truly believe the doctor that preformed the procedure just wanted to go home and did not want wait on my son to drop. I now have since changed doctors and plan to have a V-BAC she has educated me on the pros and cons and I am ready for whatever happens. I just can not take my body through that major surgery again. I am comfortable with the fact that my doctor was trained to perform V-Bacs so in my case I am comfortable.

Theresa Walsh Giarrusso

March 11th, 2010
7:48 am

I’ll dig them out after I get the kids to school — give me 20 mins.

Jeff in Roswell

March 11th, 2010
7:55 am

Do doctors ever perform c-sections on first timers just for the sake of convenience? I’m not saying I would agree with it, just wondering if it happens?

RJ

March 11th, 2010
8:00 am

I was determined to have a VBAC with my second due to the pain of the C-Section. I took VBAC classes which helped tremendously. It was the best decision I ever made. Although I still had to be cut, the healing time was much shorter.

SassyO

March 11th, 2010
8:00 am

I was surprised to hear this story on NPR yesterday, because after my first child was born in an emergency C-section, my OB_GYN encouraged me to plan a VBAC when I became pregnant again. We did, it worked, and I have always joked that I had a boy, a girl, a C-section and a VBAC, so clearly I experienced the full spectrum!

I definitely would encourage women to discuss the possibility of VBAC with your doctor.

pws

March 11th, 2010
8:00 am

With our second daughter, I asked my OB if I could try to deliver by VBAC as I had already had two C sections, the first was an emergency, and child was still born, the second, scheduled three weeks early to try and prevent what happend to the first one. He told me that he couldn’t make me have a third C section, but that he wished we would go ahead and deliver the third one three weeks early like the other. I agreed, and right before they pulled her out they counted, “one, two three”. Later during the recovery my doctor asked me if I remembered them counting and I said yes, and he stated that was how many times the cord was looped around her neck, and that she would never have made it if I had tried to have her VBAC, and wasn’t I now glad I had decided to have the C section.

I do think that some doctors deliver them for convenience, but you need to have communcation with your doctor, as patients we need to be asking “why do I need the second C section”, and if it is justified, go with it.

mee

March 11th, 2010
8:13 am

It is really up to the individual and her doctor! PERIOD. Regardless of how many articles are published and how many polls are conducted on the topic.

ldt

March 11th, 2010
8:18 am

I delivered both of my babies with a nurse midwife. I loved the experience and recommend it to anyone. I even delivered a 10 pounder with no tearing!

Tonya

March 11th, 2010
8:22 am

Mee:

Only to a certain extent. Getting a VBAC in Atlanta is VERY difficult even if you’re a great candidate because many doctors have no idea or are reluctant to perform them. If the woman is given a choice and opts for a repeat C, then it’s a choice. If the patient can’t even find a doc capable of giving her the option, how much of a choice is it really?

motherjanegoose

March 11th, 2010
8:25 am

@mee…yes, it is but if Theresa gets a chance to dig out my post you will read how a VBAC could result in a permanent disability issue for some people. I see these adults everywhere I go and my heart goes out to them as they did not recover from a difficult delivery perhaps 25 years ago. They have lived their life with the damages. My Doctor did not honor my wishes. I trusted her and she made a bad call. This is NOT the same wonderful Doctor I have now and no more babies….LOL..
Have a good day all…I am packed and outta here.

JOD

March 11th, 2010
8:26 am

I think it’s great for women to have less pressure for repeat C-sections, but if she is not comfortable or the medical situation calls for it, she shouldn’t feel like a weak buffalo in the herd as shaggy so ignorantly put it. It seems that many men – and even some women – look down on those who don’t want to or can’t have a VBAC. Different strokes…let’s not be so judgmental.

ATLien

March 11th, 2010
8:28 am

Although I have not, I have friends and colleagues who wanted to VBAC and either were told “no” by their doctors or couldn’t even find a doctor willing to let them VBAC.
Because we live in such a litigious society and malpractice insurance premiums are higher than ever, doctors don’t want to take the risk. I can’t say I don’t blame them.

Theresa Walsh Giarrusso

March 11th, 2010
8:40 am

I know why the first one didn’t show up because it had cursing in it — i;’m not sure my mgj’s didn’t show up —- shaggy I didn’t see one for you in there —

Your filter for curse words...

March 11th, 2010
8:54 am

…is hit or miss – check many of the blogs from any topic and you will see that many words worse the HE.. (which is all mine said, as in He.. NO – and I tried it with HECK NO, and it still got censored.

Well

March 11th, 2010
8:59 am

I had sense enough to stop at one

Theresa Walsh Giarrusso

March 11th, 2010
9:04 am

last week it was letting through all kinds of things — maybe they tightened it so weird stuff is getting trapped — I did complain to my boss last week that all kinds of spam was getting through —

i’ll be out for most of the morning but I will check the spam when I get back and free any trapped this afternoon –

NO, NO, NO...

March 11th, 2010
9:15 am

…and HE__NO! As a medical malpractice claim professional for over 30 years I have seen to many brain damaged baby cases due to “macho” moms blaming the OB and labor nurses after they DEMAND that they be allowed to birth the child vaginally. IMHO there should be MORE c-sections, especially at the first indication of fetal stress, and much less “let’s wait and see how the labor progresses”. Even with a nurse mid-wife in attendance, this only slows the process when those stressful situations arise, and slows down the response time for the OB to get to the hospital, set up the OR, and deliver the child in those instances where the mom is not trying to be macho.

The health carriers do not care about what COULD happen – they depend on the liability carriers to pay millions for “unfortunate events”. This may be a good segue into requiring ALL kinds of insurance carriers to contribute to pot to cover brain damaged infants, where no blame is assessed as to what caused the problems.

Christine

March 11th, 2010
9:16 am

VBAC is a safe option. Anecdotes are not what women should be basing decisions on, and good outcomes are not guaranteed regardless of mode of delivery. There are risks and benefits to be weighed for either choice.

I have had a cesarean and 2 vbacs. If you are in the Atlanta area and want support for a vbac or healing from a cesarean, please check out the Atlanta chapter of ICAN, the International Cesarean Awareness Network. http://www.icanofatlanta.com

There is plenty of good, evidence based research on VBAC vs. ERCS, including a National Institute of Health panel that was just held this week. Their statement, and resources on VBAC can be found here – http://consensus.nih.gov/2010/vbacstatement.htm

Andrea

March 11th, 2010
9:21 am

I had a VBAC with my second child with no major complications. I was concerned about it but my doctor was very thorough in explaining the pros and cons of VBAC and that really helped me make an informed decision. I was really scared of the potential complications but I think the open communication between me and my OB really quelled my fears. I was in labor for 15 1/2 hours with my 2nd but she was delivered with no complications or defects from the delivery.

I say this not to minimize what MJG and her daughter experienced but to shed some insight on the other side of the spectrum. Yes, we are in a VERY litiguous society but there are still many caring professionals that will provide the information so that you can make an informed decision on what is best for you, your family and your child.

Katie

March 11th, 2010
9:24 am

Yep, I will have a VBAC this summer. I already had one vaginal delivery before a breech C-section. Chance of rupture and fetal death is very, very low (lower than risk of amniocentesis, placenta abruptio in any delivery, SIDS, etc.). Risk of maternal injury and death are higher with repeat C-section. It’s a low risk option, and women should have that choice.

New Stepmom

March 11th, 2010
9:56 am

I think this decision is completely up to patient and doctor and the government should not be making recommendations.

I will deliver my first child in May. I have had a very difficult pregnancy and my OB was on maternity leave in January and February. Her colleagues did not read my records in her absence so yesterday I had my first appt. with her and it was wonderful. We discussed induction so that she can be there since I am so comfortable with her. She said 100% that she would induce. I know some will tell me every horror story about induction, but I trust my doc and know she will not do it too early or take it too long(without her I would probably have never gotten pregnant). It is the same situation with this. Do what feels right for you and your doc. I want to avoid a c-section if I can and I would likely never do a VBAC, but that is me and if others are up for it and their docs are willing, then go for it!

This is kind of like the abortion question...

March 11th, 2010
9:56 am

…lots of people are totally against abortion – until it is their wife or daughter, who, with as much medical certainty as possible, learn that without aborting the fetus the mother WILL die, but by aborting the fetus the mother will live. So, what choice do they make?

The same with VBACs – everything looks good, until things look bad – then, Katie, and Andrea, and Christine all blame the OB, when it was they (the mothers) who made the INFORMED decision that went south. Thank goodness for mothers like pws who did make an informed decision.

Dian

March 11th, 2010
10:02 am

NO NO NO
Wouldn’t you also say that because you are in the field of medmal claims that you also only get to see the very worst of it all. I am also in the insurance industry..and handle claims as well. For every claim you get, there also must be so many positive birth experiences that happen as well so to say that VBAC’s are risky based on your claims experience is a misnomer.

Patricia

March 11th, 2010
10:03 am

Medical decisions should be evidence-based, not based on fear of litigation, or on “anecdata.” I had a VBAC (thanks, in part, to the support of ICAN Atlanta, referenced by Christine, above). I can assure you my desire to birth naturally and vaginally had nothing to do with being “macho,” and everything to do with wanting the best outcome for my baby, and for myself, based the available scientific data.

Green

March 11th, 2010
10:14 am

Go green, have one child or none.

Toni

March 11th, 2010
10:27 am

Yep, and would do it again! I recently Vbac’ed after 2 C-sections and the recovery was better for the baby as well as myself. I reseached alot, joined ICAN of Atlanta, and found a doctor in Atlanta who was not only supportive but skilled. It is your right as a patient to be informed on all risks to any procedure, C-section as well as VBAC. So regardless KNOW THE FACTS!!!! Research and then make an informed decison not one based on fear!!!

DB

March 11th, 2010
10:32 am

Our first child 21 years ago was an emergency C-section that was performed after two days of start-and-stop labor and a course of pitocin. I was utterly exhausted, and after two days of labor, the baby’s head still hadn’t reached zero station, and the doctor said, “I think we’re looking at a C-Section, here”, and I snapped, tiredly, “YA THINK?!” Recovery was awful — I was in the hospital for a week, and on bed rest for another week.

The second baby in 1991 was a VBAC, The doctor was willing to allow me to try a course of natural childbirth, but had an anesthesiologist on hand “just in case.” I was very carefully monitored even right up to the point where I started pushing (which I never got to with the first), and the anesthesiologist hung around until the baby was born and the doctor told him he was clear. The difference in recovery was night and day — omigod, I felt like DANCING two days later, instead of feeling like I had been hit by a Mack truck!

It wasn’t a case of me wanting to be a “macho” woman — anyone who knows me would laugh at that description! Honestly, the main reason I wanted “natural” was because I was too squeamish to get an epidural –the idea of sticking a needle in my back made me nauseous!

Each person’s pregnancy is different – while my VBAC experience was extremely positive, I was also aware that I was being watched like a hawk for the least possible sign of trouble, for which I was grateful. There are so many factors that play into each pregnancy, even with the same mother from pregnancy to pregnancy, that it would be impossible to predict ahead of time what would be the best course of action. One never knows how a delivery will play out — as my husband commented, “She wants natural, and I’m fine with that, as long as she’s surrounded by millions of dollars worth of medical technology.” :-)

Elaine

March 11th, 2010
10:38 am

I had a VBAC after 2 prior cesareans here in Atlanta 2 years ago. Thanks to ICAN of Atlanta I was able to interact with other VBACing mothers and locate an OB who supported me. I was able to safely birth my baby and avoid a 3rd major abdominal operation. Because I avoided surgery, I was able to start mothering my new baby and caring for my other children immediately, rather than being a pain-ridden post-surgical patient.
Maternal death rates are up in the USA, and one of the reasons attributed is the rise in cesarean sections.
The medical evidence is in favor of VBAC. Doctors need to practice evidence-based care, not fear-based care.

Blair

March 11th, 2010
10:40 am

I just had my VBAC a month ago. I would do it again in a second–I had a very good and safe birth with an extremely skilled and supportive care provider. There is a lot of good information out there about the safety of VBAC, and you have to also consider that while cesareans are a relatively safe surgery and can be life-saving during times of emergency, they are still major surgery and not without risks. The New York Times was reporting on VBAC because there was a huge conference on VBAC at the National Institute of Health in Bethesda, Maryland this week. There was a ton of great info presented by leading researchers in the field of obstetrics and maternal and fetal mortality. The conference published their first draft of their consensus yesterday and they believe that VBAC is a safe option and is urging physicians and other medical bodies to support it. I agree with the previous poster that medical decisions should be evidence-based!

Christine

March 11th, 2010
10:43 am

I didn’t blame the OB? I said to research and make a decision based on facts. Like the ones from the National Institute of Health that I provided.

TnT's Mom

March 11th, 2010
10:45 am

My first was a somewhat emergency C-section after 12 hours of no progress labor and large baby. Second baby was an induced (2 weeks prior to due date) VBAC. All went well. he was born just 7 hours after they started pitocin and broke my water, I was very carefully monitored the entire time. Having experienced both, the 2nd recovery was much easier. Would have chosen a VBAC if I had a third. but, youngest is 12, not haveing any more, thank you.

As some have said, each mom and even each mom’s pregnancy is different and her and the doctor need to make an informed choiced based on her circumstances. Yes, bad things happen, but they can happen in all types of situations too.

RJ

March 11th, 2010
10:46 am

Forgot to mention that my VBAC was performed by a midwife. That was the best experience ever! I didn’t like the OB-GYN on staff so I was sooo relieved to see her and told her so. I don’t think that I was being “macho”. I was simply remembering how I felt after having a C-Section. It was very painful.

People should research, talk to a professional and make an informed decision.

My VBAC classes and delivery was performed with Kaiser Permanente at Cascade. I haven’t been with them for many years, but I appreciated all of the classes and great mid-wife. It can be done in Atlanta. My 11 year old is living proof! He’s 5′4″ and weighs 103lbs. A healthy growing boy!

Nadia74

March 11th, 2010
10:47 am

While I understand that motherjanegoose had a traumatic second birth experience, I do not see how it was a result of her having a VBAC. Yes, maybe her doctor should have performed a c-section and was hoping to increase VBAC numbers, but what happened could have happened to anyone attempting a vaginal birth, whether after previous c-sections or vaginal births. I think a lot of people see stories like hers and think VBACS are dangerous. It is my understanding that the risk of having a VBAC is the chance of uterine rupture, which is less than one percent. If she had said her uterus ruptured, causing damage to herself and/or the baby, then I would say her anecdote was relevant. Don’t let stories like hers discourage you from attempting a VBAC.

Having a nuchal chord (chord wrapped around baby’s neck) does not neccessitate a c-section, either.

From https://www.marchofdimes.com/professionals/14332_4546.asp

What is a nuchal cord?
About 25 percent of babies are born with a nuchal cord (the umbilical cord wrapped around the baby’s neck) (1). A nuchal cord, also called nuchal loops, rarely causes any problems. Babies with a nuchal cord are generally healthy.

Sometimes fetal monitoring shows heart rate abnormalities during labor and delivery in babies with a nuchal cord. This may reflect pressure on the cord. However, the pressure is rarely serious enough to cause death or any lasting problems, although occasionally a cesarean delivery may be needed.

Less frequently, the umbilical cord becomes wrapped around other parts of the baby’s body, such as a foot or hand. Generally, this doesn’t harm the baby.
******************

I had a c-section and two VBACS. My second baby was in distress towards the end of my labor and was blue and not breathing when born (her Apgar score was a 3). The doctor knew something was up, but I did not need a c-section. She just had the baby team in the room and ready to work on the baby. That did not discourage me from vbacs, and I went on to have my third child vaginally.

Long labors, big babies, blah, blah, blah…these are all reasons people think they need to have c-sections. It is just nature doing its thing. I had “long” labors with all of my babies. I did not see that as a reason to ask for a c-section, though. The only time I ended up with a c-section was when I did not let things progress naturally and was given pitocin because I was having no contractions on my own.

To answer your questions, yes, I had 2 VBACs. No, I felt no pressure from my doctor to have a repeat c-section. My doctor assumed I would have a c-section. We discussed it at one of my first check-ups for that pregnancy. I corrected her assumption and said I wanted a vaginal birth. She told me the risk for uterine rupture was extremely low and did not try to convince me to have another c-section. It was a two minute conversation. At the time, I had no idea that people thought VBACs were such a big deal. I did not know there was an issue there.

No, I was not afraid to deliver vaginally. I was excited and afterwards, I felt amazing. It was such a different experience afterwards, compared to recovering from surgery and having a newborn.

Yes, it is important to increase the number of VBACS!!!!

Elaine

March 11th, 2010
10:55 am

Yesterday the National Institutes of Health concluded that the main reason in the decline of VBAC is *not* based on medical reasons. And that VBAC does not pose a greater risk to women or children
Listen to the story
http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=124559259&m=124559282

nurse&mother

March 11th, 2010
11:32 am

My two cents:

I think that vaginal deliveries vs. Cesareans should be reviewed by the doctor or midwife on a case by case.

I think that there are many c/s that are done too early. (probably out of fear of litigation and some for convenience)

I do think that ob’s are afraid of being sued. Who wouldn’t be. Your good name (and practice) is on the line. It only takes a bad delivery to stand out against all the good ones.

IMHO, sometimes bad things happen despite the excellent care of the provider and L&D nurse. But most of the time, nurses and providers are on top of the situation and can tell when plan B needs to be implemented.

I disagree that everyone just needs to be lined up for a c/s. A C/S is surgery and there are risks (infection, clots, hemorrhage, death).

I think a good dose of common sense needs to be used.

I had a patient who VBAC’d many years ago. She had a uterine rupture. The baby almost died. I’ve also seen many successfully deliver a healthy baby via VBAC.

Medicine should never be a cookie cutter approach. If you had such approaches, trained monkeys could be doctors and nurses.

Michelle

March 11th, 2010
11:40 am

Well, my first and only was a c-section. He was already 10 days late! She did an ultrasound, and it showed I had VERY LITTLE amniotic fluid left (which is an indicator that the placenta is deteriorating). So, I was induced. After 18 hours and 2 rounds of Pitocin I still hadn’t progressed past 4. They broke my water at that time. By 20 hours there was still no progress and he was starting to show signs of distress so they did a c-section at 22 hours! My doc thought he’d be around 6-7 pounds…nope…8 pounds 6.2 ounces!

People here these stories all the time. I tried, but it just didn’t work for me. I think the reason that c-sections are up is that doctors “schedule” the births for convenience of themselves and their patients. I cannot tell you how many people I know that were scheduled for a c-section their first time! WTHeck?!

Personally, unless there is a complication, I think women should deliver vaginally! That’s how they are meant to be! I do realize that things happen and that should be the only reason to get one!

As far as the VBAC, I think you can get hordes of support for either side! Personally, I’d be scared. I think if I felt 100% secure with my doctor, I would consider it. Being in the medical field, I have heard all the “stories” about why it shouldn’t be done!

I agree with the many posters that state it should be the mother’s decision. I would definitely make sure there was PLENTY of monitoring going on in the delivery area though!!