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?
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243 comments Add your comment
Jamie
March 11th, 2010
3:30 pm
Well I know you being a nurse makes you immensely qualified but according to the National Institute of Health as well as the World Health Organization and just medical facts in general: A repeat c-section is many times (more often than not) MORE risky than a VBAC. And of course all c-sections aren’t done unnecessarily and yes there is a slightly increased risk of uterine rupture. But the point I was making was that many inital c-sections happen for the same reasons VBACs don’t happen an OBs (very real and legitimate) fear of litigation. So I was saying its hard to reconcile the 2 points that an OB has the right to refuse a VBAC for fear of litigation but then to say we need to prevent unnecessary initial c-sections when many are done because of fear of litigation.
nurse&mother
March 11th, 2010
3:31 pm
Christine,I am saying that folks who come into the delivery room with an attitude, are in essence using vinegar. I’m merely saying come in with a positive attitude. If you don’t trust your doctor find someone else. If you trust your doctor, then there is no need to come in with an attitude. An honest yet respectful attitude will go much further with your OB team.
high risk for a VBAC is the OPPOSITE of my earlier post ” 1. they have already had a vaginal birth (without complications) and 2. When the C/S was for something like fetal distress and NOT for large baby, cephalopelvic disproportion, etc.”
SO therefore, I am saying if you had a large baby the first time and the baby wouldn’t come down into the pelvis, or your were sectioned for failure to dilate OR you haven’t had a successful vaginal delivery EVER, then you are high risk. Is that any clearer?
nurse&mother
March 11th, 2010
3:35 pm
Jamie, your point is well taken, but one of my points is that doctors don’t have to HAVE to allow their patients to VBAC. WHile they can’t force a woman to have a cesarean,they may highly recommendone, (they cannot operate without the patients’ consent otherwise there would be a lawsuit waiting to happen).
Like I said earlier nothing is cut and dried. Mostly gray areas.
Christine
March 11th, 2010
3:38 pm
It is clearer, but it is not entirely factual. Having a prior vaginal delivery (or a prior vbac for that matter) does put you at slightly lower risk for uterine rupture. (Slightly lower than very little, though). However, having a c-section for failure to descend or CPD does not put you at any higher risk of uterine rupture. It *may* make you less likely to have a successful vbac (and I say “may” because many cesareans for FTP/CPD have mitigating factors such as induction, epidural, malposition, etc that can be different in subsequent pregnancies) however there is no addition risk in attempting the VBAC.
Blair
March 11th, 2010
3:39 pm
Wow N&M, I’m really glad you weren’t my OB. With my first baby I had gestational diabetes, medicated with insulin, and my c-section was for “failure to progress” with suspected cephalopelvic disproportion, and my second baby was suspected to be 10-11 lbs at term. I had never had a successful vaginal delivery EVER until my VBAC three weeks ago. Despite all this my OB told me I had a GOOD chance of VBAC (it’s actually a box he has to check on the consent form) and he was right! And my VBAC baby was a pound bigger than my c/s baby. Go figure. I wonder what would happen if more women got TOL? Hmm… funny, NIH is wondering the same thing!
Jamie
March 11th, 2010
3:43 pm
N&M I see what you are saying as well so maybe the goal should be more education as medical “consumers” because many make decisions not knowing choices and what are true safe options. I agree with you on it being mostly gray areas and to be honest I would never want to be an OB (as it seems everything is a lawsuit waiting to happen). I don’t think they are evil people just looking to slice women open, they have hard decisions to make and I don’t think there is a problem with OBs but with the system (both the medical system and litigation).
Practice obstetrics is like piloting a commercial jet...
March 11th, 2010
3:46 pm
…hours and hours of sheer boredom, followed by moments of sheer terror…
nurse&mother
March 11th, 2010
3:59 pm
Blair, I never said that those who were sectioned could NOT deliver VBAC successfully, I just said it was higher risk (and implied that not as likely,) but I never said it couldn’t happen.
Secondly, I don’t make those kind of medical decisions as a nurse. Nurses are not allowed make physicians decisions. I’m wondering what hospital you delivered where you would even think that your nurse could made a decision on what kind of delivery you were going to have. Sounds like they have much more autonomy than we do at our hospital.
BTW, I am happy for ALL women who end up surprising the medical staff with a vaginal delivery (when it is questionable on whether or not she will have a vaginal delivery). Who wouldn’t be? I haven’t met a doctor yet who was pissed off when someone delivered vaginally.
That said I refuse to be suckered into this discussion any further.
@ Practice Obstetrics… pretty funny ;-)
New Stepmom
March 11th, 2010
5:11 pm
N&M, can you come to Northside when I deliver? You are very matter of fact and remind me of my doc whom I adore. I think you are illustrating the medical side of things very well. As a first time mom who is somewhat terrified of the whole process, I think that any patient in your care would be lucky!
Anonymous
March 11th, 2010
5:16 pm
New Stepmom,No nurse can save you from Northside’s sky high c-section rate.
nurse&mother
March 11th, 2010
5:21 pm
Aww, thank you New Stepmom. Judging by other posters, you could be in the minority. haha. On a serious note, I try to care for my patients as if it were my sister or best friend. I feel like I use a great deal of common sense. Thanks again for the compliment. I would love to be with you for your delivery;-) I wish you the best. When are you due?
nurse&mother
March 11th, 2010
5:34 pm
I am only posting this tidbit of info because I should have presented it earlier.
One of the things that makes it risky for a VBAC is if the doctor has to induce labor. It the patient comes in laboring on her own it is a little different (and one of the situations where many doctors are likely to let a VBAC labor) than if she has to have pitocin to induce labor. When pitocin is used, it usually means the body is having to be “coerced” into labor. The pitocin can be a contributing factor to uterine rupture(and is generally contraindicated) for a scarred uterus.
Christine
March 11th, 2010
5:56 pm
Pitocin does increase the risk of UR, although not nearly as much as prostaglandins which are contraindicated for a VBAC. Pitocin augmentation does not raise the UR rate, while pit induction does, which may have more to do with, as N&M said, a body that is not ready to go into labor.
Being induced isn’t ideal for VBAC (it isn’t ideal for any labor) but it is something you would want to consider carefully.
New Stepmom, why are you scared? Have you considered hiring a doula to be with you at the birth? I have to agree with Anonymous that Northside is not my hospital of choice, but hiring someone to support you would be a great idea. Also are you planning on taking a childbirth class? As we were discussing in the comments with Mr. Med Mal ;) An informed mom is an empowered mom :) Congratulations on your first baby!
fk
March 11th, 2010
6:19 pm
My son was a section baby. If I had another, I would have opted for the section again. I was induced for 3 days with no progress, even once my water broke. He was born at 11 pm on a Sat. nite and I was released first thing Tues. a.m.. Of course, there were restrictions, but I was not in pain, just a bit slow moving ~ and happy to be home with a healthy baby. He was perfect.
Blair
March 11th, 2010
7:11 pm
N&M, I never meant to imply that a nurse would be a part of the decision-making process as to whether to VBAC. I was just pointing out that your qualifiers, as outlined in your comments, for who may or may not be “high risk” aren’t the same ones my physician uses.
If you have any personal investment in your patients’ safety at all I strongly urge you to at least read the abstracts from the NIH conference.
New Stepmom
March 11th, 2010
7:14 pm
N&M, I may be in the minority, but I know that people died from childbirth for years and the medical establishment has reduced that tremendously. I appreciate what Labor and Delivery staff do and figure you guys know enough to make good recommendations for me and my child.
Christine, I am frightened because this is my first baby and there is so much that is unknown, could go wrong and I have had a difficult pregnancy. As for being empowered, I am as well read and educated on the subject of child birth as you are, I just feel very differently about the situation than you. My only goal for my delivery is not the “birth experience” that has come into vogue, but to have a healthy baby delivered at the end. For me, the process is not about me, but my child and if that means a c-section that my doc recommends, I am fine with that. A doula would stress me out, because I am not into the trend of community birth and know that a superfluous person coaching me would be more annoying to me than anything else. I am not knocking the choices of others, but for me, the right choice is a medically attended birth at a hospital with a fantastic labor and delivery unit and all of the NICU bells and whistles in case something goes wrong. Quite frankly, my husband being in the delivery room is not even that important to me and he knows that.
As for Northside, it is a top ranked hospital for a reason. I would probably prefer to deliver at Piedmont because they do care more for the mom than the baby, but if there is an issue my child would be life-flighted to Northside, so why not save the helicopter ride. Also, my doc who I owe a lot to only delivers at Northside.
Again, I am not knocking the choices of others, but for me and my baby the new birthing trends do not work.
Michelle Frank
March 11th, 2010
7:40 pm
New Stepmom,
I’m afraid you are unaware of the other top level NICUs in Atlanta; Northside is NOT the place your child would be life-flighted to, should it be necessary after delivery. And putting yourself aside, if you were as well informed as you espouse to be, then you’d know that a c-section carries pertinent risks for your baby also. Besides the risks to the baby from a surgical delivery, what about the risks to your life, too? Do you not care what condition you are in to care for your newborn just as long as it is healthy? I’ll end this by saying that I think it’s sad that you are willing to put both your life and your unborn’s child life solely into the hands of a L&D team. So much for being empowered…
momto5+1
March 11th, 2010
7:45 pm
New Stepmom, I’m not sure what you mean by “community birthing” or new birthing trends. A doula is just a support person who stays with you, like asking N&M to be your nurse, except that the L&D nurses can’t stay with you the entire time, while a doula can. A doula helps you get the birth you want, whether that is a medicalized birth with NICU bells & whistles, a waterbirth, or anything in between. A doula is someone who helps a family advocate for themselves, helps them ask questions to make informed decisions and is not employed by the hospital, but by the consumer. Doulas (simply another woman) have been around since before dr’s were attending births. Not exactly new or trendy.
Anyway if you don’t feel it would be of use in alleviating your fears, save your money.
Cassie
March 11th, 2010
7:50 pm
New Stepmom, you are NOT as well read and educated on childbirth as Christine is. Hellooo!!! You have NEVER had a baby!!! You said this is your first! It is so obvious to anyone who reads your comments (even people who disagree with Christine) that you are so, so Naive!!
Patricia
March 11th, 2010
8:28 pm
Wanting a “good birth experience” is a trend? Something that has recently “come into vogue”? Are you kidding me?? You care more about your baby than yourself – that is wonderful, admirable – but remember, your baby has to “experience” his or her birth, too. I am all for any intervention that is truly necessary to keep baby and mother safe, but sometimes those “bells and whistles,” as you call them, are very traumatic and harmful *for the baby.* As is anything that compromises *your* health, or compromises your ability to breastfeed or otherwise bond with your newborn. Being nervous is normal, but please don’t be scared. Wishing you the very best.
New Stepmom
March 11th, 2010
8:33 pm
You are all right, this is my first baby. BUT, I have worked with a doctor for 6 years just to save my fertiliy and become pregnant due to a lot of female issues. I am not trying to say anyone’s opinion (and that is what they are with the exception of the nurse) is wrong, just let those that offered advice what my view is of how this process needs to work for me. I do not want to have a c-section at all, but if it becomes necessary-I will do it. Again, a doula is not for me. I have read and re-read anything I can get my hands on (I have been on bedrest for 4 months and will be until I deliver, so I have lots of time) and I am educated about the process, I have just made very different choices than you guys.
I think what nurse and mother said earlier about honey and vinegar applies here….
Thanks Nurse and Mother!!!!
New Stepmom
March 11th, 2010
8:35 pm
@ Patricia, nervous is probably a better word than scared. Thank you for the well wishes even if we do not see eye to eye.
momto5+1
March 11th, 2010
8:38 pm
Actually, the nurses opinion, is an opinion as well. The links Christine posted show where actual evidence based info can be found.
Christine
March 11th, 2010
8:41 pm
New Stepmom, I can appreciate infertility and bedrest as I have experienced both. I did congratulate you and was just making a suggestion that having someone there who knows the ropes, like a doula, might be helpful to calm your anxiety. I wasn’t trying to suggest what type of birth you have or anything like that. As I said before I am a birth advocate and that doesn’t mean I only advocate for the type of birth that I would want. If you are educated and empowered, good for you. I just didn’t get that impression from your post about being terrified.
Jamie
March 11th, 2010
9:02 pm
New Stepmom even the nurse said that initial c-sections are too common so I think even if you just believe what she said to be fact there still is a cause for concern. A c-section isn’t just a bad “birth experience” its major abdominal surgery.
Nadia74
March 11th, 2010
9:06 pm
New Stepmom, you might try being a little wary of believing everything you read or hear from medical professionals. Being a medical professional does not make you informed. New studies come out with statistics and data all the time, but that does not mean your medical professional has read them. Case in point: Breastfeeding is the best for a baby, yet there are many nurses who discourage women from breastfeeding or tell them formula is just as good as breastmilk. You will not find one study that shows that formula is as good as breastmilk, yet you will find many nurses who say that it is.
A lot of doctors find c-sections to be an easy way out, they don’t care about the numbers or the hard data that shows that VBACS are safe or that primary c-sections are pushed and women are not allowed to progress naturally in labor. Those doctors don’t take the time to research and read the latest information and make their decisions based on that.
I would hate for you to take anything a “medical professional” says as hard facts just because they say it. My doctor told me I could not breastfeed while I was pregnant. However, there was no medical reason that I could not or should not. You know what? My doctor did not have any good reasons to to give me, and she admitted that it was something she had not dealt with previously. She had just heard that it “could start premature labor,” (because breastfeeding can cause your uterus to contract) but she had no actual numbers. I never had contractions from breastfeeding, but if I had, I am informed enough to know that I would have needed to wean my baby for the sake of my pregnancy. I had no history of preterm labor, so I was not worried about the “risks” of nursing during pregnancy, and if risks started to present themselves, I knew that they were not going to be detrimental to my pregnancy, and I could just stop breastfeeding. I continued to nurse throughout that pregnancy and throughout my third, with no complications. Later, my doctor told me that because of me, she has had more patients wanting to nurse through pregnancies and she has encouraged them because of her experience with me.
What I am trying to say here is that sometimes doctors (or nurses) have very good intentions, but they are not always right, and everyone that has said to empower yourself is completely right.
Think about it: A nurse could have witnessed ONE uterine rupture and it was such a traumatic experience for her that it has skewed her thinking, so she now thinks all VBACs are horrible. However, that does not change the statistics, not all VBACs are risky.
Just look at actual facts. Try not to be influenced by horror stories. Those stories make up a small percentage. There are so many more uneventful pregnancies. Be informed by actual facts, not influenced by opinions.
irisheyes
March 11th, 2010
9:09 pm
New Stepmom, you’re going to be a great mom! It seems like you are looking at childbirth the way everyone should. Sure, we all have a goal of how we want childbirth to happen, but isn’t a healthy mom and baby really the goal? I had three c-sections, the first because of CPD (his head was 15 inches around). My last two were elective, but only my middle son would have had a chance of being a VBAC. I debated and discussed all of the issues with my midwife, but, in the end, I decided that a c-section was the best. The hospital where I delivered him was a small, community hospital, and there was not an anesthesiologist there all the time, so if I’d had a UR in the middle of the night, they would have to call in someone. My midwife said that she had never lost a baby, but she wanted me to know all of the facts. My third was elective, but he had sagittalsynostosis, so his head would NOT have molded in any way to make it down the birth canal. Again, it’s between a woman and her doctor. Anyone with half a brain can do the research. I’m not a better mom because I had a c-sections, and women who have gone all natural are not better moms than me.
motherjanegoose
March 11th, 2010
9:11 pm
Of course, for every opinion, there is a opposite opinon.
I recovered beautifully from my C section, nursed my son for 10 months and enjoyed the entire time.
Bringing home a child with Erb’s Palsy after a VBAC, was one of the most horrendous experiences in my entire life. I sat in the rocker and nursed my daughter who was paralyzed, due to a VBAC, and CRIED my eyes out.
Suit yourselves…everyone makes their own choice.
If you can look in the mirror and tell yourself that you will accept whatever transpires, after a VBAC, you are a MUCH bigger person than me.
Night all!
A Genius
March 11th, 2010
9:12 pm
The key here is figuring out what is a fact and what is an opinion. Who in the above posts references actual statistics and research? And who hasn’t? You can listen to “medical professionals” spout off information all day and night. I usually listen to the ones that can actually back it up with documented research.
nurse&mother
March 11th, 2010
9:15 pm
Anytime, New Stepmom! BTW, I’ve seen a few doulas get fired in the delivery room. I’m not knocking them catagorically (just mentioning that tidbit).
I sincerely hope everything goes smoothly! It sounds like you have a good head on your shoulders. You are welcome to contact me via email if you have any questions/concerns (and would like my opinion). Theresa can give you my email. She knows how to get in touch with me through facebook as well;-)
Nadia74
March 11th, 2010
9:16 pm
Oops, I made it sound like I started some revolution of women wanting to nurse during pregnancy. I meant that my doctor has had patients since me that have wanted to nurse during pregnancy, and she knows now, due to her experience with me, that there is no reason to discourage it.
A Genius
March 11th, 2010
9:17 pm
Nurse&Mother–Why would you even mention that? It just seems like you are putting down doulas for no exact reason.
nurse&mother
March 11th, 2010
9:18 pm
A genius. I actually attend nursing conferences and am a member of AWHONN (Association of Women’s Health Obstetric and Neonatal Nursing (which btw, give perinatal guidelines).
And just what do you do for a living?
nurse&mother
March 11th, 2010
9:21 pm
I will keep my opinions on the matter to myself, thank you ;-)I’d prefer not to get into a pissing contest tonight. I am actually studying for my certification exam in Inpatient OB to become certified.
A Genius
March 11th, 2010
9:21 pm
Why do you keep asking that question? What the heck does what I do for a living matter when all I am saying is how I make INFORMED decisions. I have yet to throw out a single statistic. ;) And since you have attended so many conferences and worked as an L & D nurse for so long–why is the SAHM blowing you out of the water? Statistically speaking….
A Genius
March 11th, 2010
9:22 pm
And based on what I have read, it looks like something of a pissing contest has been going on all day.
Michelle Frank
March 11th, 2010
9:22 pm
N & M, I’m pretty convinced that it is nurses like you that are part of the reason so many of us specifically avoid delivering at Northside. You are a knife-happy OBs dream, and don’t we all know that Northside has plenty of those OBs roaming their corridors. OH wait, they probably don’t step out of the OR long enough to actually roam…
Gigi
March 11th, 2010
9:23 pm
I am pro-choice, whether that is a vbac or a cesarian. Having had the most unfair cesarians of all- no troubles at all with my pregnancy, when my OB+ midwife started to feed me with horror stories to coerce me to a cesarian so they are over and done with- that was at a private practive in, where 80% of women are routinely cut.
I am more wise now to what coercion is and not only physically, but emotionally I want freedom of choice and informed choice!
VBAC’s are safer, but only if the medical professional attending is there near you and not just dumping you on an NST machine ( one of the most unreliable inventions)…many of the accidents quited happened when women were ignored, induced and generally by practitioners that did not somehow take into account that a VBAC mother would need a gentler birth, less intervention and more time.
Thus if some practitioner has all that, then he should give a VBAC,,,if not just opt out so that the mistakes of the late 80’s and 90’s dont happen again.
Then VBAC is a safe choice,,,and much safer than repeat cesarians that are not needed.
motherjanegoose
March 11th, 2010
9:25 pm
No statistics on my end….just first hand experience of having a child with a VBAC birth injury, lots of tears and pictures to confirm it.
If you take the downtown connector in Atlanta to the airport ( as I do) and someone told you:
DO NOT TAKE IT ON MONDAY MORNING BETWEEN 7-8…. ( just an example)
do you need statistics to pay attention…not me….
While I am the queen of strong opinions…I also pay attention to others when they have “been there…done that…”
suit yourself…my daughter is 17 and 90% recovered….
nurse&mother
March 11th, 2010
9:25 pm
I have an idea. Why don’t all the lay professionals (who have such condemnation for the L&D doctors and nurses) come and deliver all the babies. If you guys know how to do it better than doctors and nurses, get your big hineys back to med or nursing school and do something about your knowledge. Now THAT is an idea.
Elaine
March 11th, 2010
9:26 pm
motherjanegoose. Your child didn’t have Erb’s Palsy because of a VBAC. Your child had Erb’s Palsy because of a poorly-managed shoulder dystocia. Erb’s Palsy can happen in any birth situation, regardless of whether or not a mom has had a prior cesarean. This isn’t a side-effect of VBAC.
Additionally, erb’s palsy can occur during a cesarean section as well.
nurse&mother
March 11th, 2010
9:27 pm
precisely why I don’t want another one, rocket scientist;-)
momto5+1
March 11th, 2010
9:29 pm
Plenty of nurses have been “fired” in the delivery room as well and many more who should’ve been. I have seen OB’s who have also been thrown out of the labor room as well and some who have performed harmful interventions as a way to get back at laboring women who ask questions. No, it certainly doesn’t happen at every birth, but really, it shouldn’t happen at ANY birth.
Simply attending hospital births as a nurse does not make one the end all be all of childbirth information. There are many people (including OB’s, nurses, doulas, midwives, childbirth educators, advocacy groups, etc) more than capable of educating on the topic of childbirth which includes VBAC’s.
nurse&mother
March 11th, 2010
9:29 pm
the funny thing Michelle, is actually I am not pro c/s except in some VBACS. You may think whatever you want, but if you would actually read ALL my posts, you would see otherwise. L&D is not a cookie cutter approach (on EITHER side of the argument).
Good night all.
Gigi
March 11th, 2010
9:30 pm
Dear motherjanegoose….i am sorry to hear what happened to you, but that was not due to the vbac,,,,when we talk about vbac risks it is more the rupture….what happened to you could happen in any delivery – even if you never had a cesarian before.
I assume that even a first time mother that went to labour can be presented with the same problem.,,,but what OB’s HAVE to do is to carry mobile ultrasounds and check what is happenening and the labour is not progressing…is it only that the child is not coming down quick enough or there is an underlying reason….that is the problem…i do not understand why they dont do it…they have equiped labour rooms with all those NST machines that 1/2 the time dont attach properly to the belly and then no ultrasounds….
A Genius
March 11th, 2010
9:30 pm
With all due respect, I would question still question why someone told me to do something a certain way. I am very empathetic towards those who have gone through traumatic birth experiences. It is clear how that would influence your attitudes and opinions one way or the other. Unfortunately there are many instances where you can find someone with a horror story to tell. Sad.
Melissa
March 11th, 2010
9:32 pm
I also had a VBAC after having a c-section for “failure to progress” with suspected cephalopelvic disproportion. With my July 2009 VBAC, I was 15 days late and delivered a healthy 9lb 4oz baby. 1lb 4oz bigger than my c-section baby. It was a long labor, 20 hrs and I had to have pitocin to augment my labor. VBACs can be done, even with FTP and CPD previous sections. There are just so few options at trying to VBAC in Atlanta, not to mention where it is banned in hospitals across the country. That is just not right. Women should be given the option to VBAC just as they are given the option for a repeat c-section.
RPQ
March 11th, 2010
10:00 pm
“One of the things that makes it risky for a VBAC is if the doctor has to induce labor. It the patient comes in laboring on her own it is a little different…” Therefore if a mom (scarred uterus or not) begins labor on her own all the better right? All the more reason to leave well enough alone.
“… pitocin can be a contributing factor to uterine rupture…” So, is this common knowledge among OBs and L&D nurses? If so, why is this not being discussed with moms (other than being “disclosed” in the fine print on one of the numerous pages you have to sign when you’re checking into the hospital)?
To quote some more, “When pitocin is used, it usually means the body is having to be “coerced” into labor.” Therefore, scarred or not pitocin can lead to adverse effect such as UR.
Given this knowledge, WHY are inductions with pitocin [combined with a cervical ripening agent or alone] common place these days; barring all medically indicated reasons (hypertension, preeclampsia, heart disease, bleeding during pregnancy, there is an infection inside the uterus known as chorioamnionitis, the amniotic sac has ruptured but labor hasn’t started within 24-48 hours or the baby is in danger of not getting enough nutrients and oxygen from the placenta and showing signs of distress usually due to going PAST 42 weeks gestation)*
Could it be because the care for pregnant women over the past decades has become over managed?
What’s that all-time favorite line among obstetric care providers, “Nothing good happens after 40 weeks.” What? So, I guess obstetrics has finally become wiser, more insightful and authoritative than the innate biology of the human female body (with the occasional exception).
Jamie
March 11th, 2010
10:10 pm
motherjanegoose I do not think anyone would dare to argue that what happened to your family was not awful and if the same situation had happened to me I might make the same choices and have the same feelings as you but I do not think it is ground to make a blanket recommendation. To use your highway example so even if statistics show that when you travled the highway and encountered traffic that was a rare incident that only happens a very small percentage of the time(although in real life in Atlant we know this isn’t the case its just a for instace) you would still say no one should travel that route? I just read a story about a newborn who got cut during a c-section and died because of infection but this does not mean that no one should have a c-section.
RJ
March 11th, 2010
10:22 pm
To the the medical malpractice claims professional: step out of the office and into reality. While you’re there maybe check out some of the research which show the outcomes for vaginal birth vs. cesarean. The less you mess with birth (and that includes doctors inducing, “clocking,” medicating, vacuum suctioning, and otherwise fiddling with the process) the better the outcome tends to be. VBAC may not be as safe if a doctor decides that a woman needs to be induced for fear of sudden rupture after the magical date of 40 weeks or chooses to augment with pitocin, or even worse uses Cytotec (which can rupture a previously unscarred uterus just as well). But again, more meddling, worse outcome.
The risks of VBAC are as high as the risks of laboring for the first time mom. So either no one should get pregnant and give birth, everyone should have cesareans all the time (although that has more risk so not a good option after all), or moms should be encouraged to give birth vaginally and supported in every means possible to do so.