Will VBACs make a comeback?

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….

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And when I reposted it said I already said that…

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And when I reposted it said I already said that…

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GRRRRRRRRRR

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…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…

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

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

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

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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.

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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.

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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!

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@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.

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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.

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…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.

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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

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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.

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…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.

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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.

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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!!!

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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.

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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.

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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!

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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

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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!!

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My wife just had a VBAC, and I’m glad that she had the opportunity. All patients should have the right to truthfully assess the benfits and risks concerning any procducres, including VBAC vs. CBAC. A one size fits all approach, such as “We don’t do VBACs. PERIOD.” ignores the potential risks of multiple repeat c-sections.

I do feel that the rate of primary C-sections should be lower, as it is a major surgery that’s unfortunately treated as a routine procedure.

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…I didn’t say “VBAC’s are risky based on…claims experience” – what I think is that many who are reading and commenting here missed a very important part of the article – “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” (emphasis added).

My point was that in risky situations ALL participants (mainly the mother and her OB/Mid-wife) SHOULD consider the BEST alternative to the potential risk of complication. We all know that MOST births are without problems – we are only concerning ourselves with those known risky pregnancies. And, I maintain, that both the mother AND her OB need to make better INFORMED decisions at the height of the situation at hand, and not prolong (like motherjanegoose’s OB did) the situation. I am not sure what your situation at Grady is, but I can assure you that the OB’s who practice there live dangerously if they adhere strictly to the ACOG recommendations.

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I would like to add that VBACS are a better option for moms that request it when: 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.

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Christine, I would agree with you if the patient signs a waiver (that would actually hold up in court) that she understands the risks and agrees not to sue for complications (should they arise) as a result of the VBAC.

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nurse&mother, all patients have to sign an informed consent that outlines the risks of vaginal and cesarean birth. having a prior c-section for CPD doesn’t mean a vbac is any riskier for you. and women who are more informed about their options and take a bigger part in their own care are LESS likely to sue if something goes wrong.

of course a doctor shouldn’t do something he/she doesn’t feel is safe, but many OBs/Midwives are not practicing evidence based medicine. the studies do not back up the “facts” that they tell women about vbac vs ercs

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i’m not saying that fear of being sued doesn’t effect how doctors practice, but I don’t think the answer is to force women into surgeries that they don’t want and present risks of their own. I also don’t think that a family should have to waive their right to protection from malpractice for choosing to try and avoid that surgery.

I am a stay-at-home-mom and a volunteer birth advocate. I am on the Board of Directors of ICAN.

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This is precisely why many doctors won’t delivery VBAC. They have no protection from a suit prone society. There are a few that will agree to VBAC with the criteria mentioned in one of my previous posts.

Have you ever attended any legal issues regarding labor and delivery?

I’d be willing to bet that if you were a physician and had worked hard (not to mention the DEBT they have incurred during school) to be where these docs are, you would want to protect yourself as well. It only takes one bad outcome to change your world.

I wholeheartedly agree with patients rights. While I agree with VBACing when a patient is LOW risk, I understand that not all women are good candidates. And I respect the doctors that make decisions to refuse to deliver VBAC when the risks are high. Have you ever been present for a uterine rupture and the baby almost died (or ran the risk of being permenantly compromised)? If not, they you are not properly informed.

I can certainly understand why some women would want to VBAC (when it is their choice).

I also understand that not all patients know what is best for them. Take for example, those folks like Michael Jackson who had surgery after surgery after surgery to reconstruct his looks. Did he find a surgeon that would perform the surgeries? Yes. Was it wise on the part of the surgeons? probably not. Just because a patient wants something, doesn’t mean he/she can always look at the bigger picture.

Just my medical opinion. It looks like we probably won’t see eye to eye on this one, so I will try not to comment further.

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“… I don’t think the answer is to force women into surgeries that they don’t want and present risks of their own.”

Just because a Doctor doesn’t provide a service doesn’t mean that a woman is forced to do anything. You can find another doctor.

This is not something that you decide at the last minute. On your first visit, you can ask the doctor if they are willing to give it a try.

We all have a different risk tolerance. Some women might be willing to try when others would not. If they say, “Well, your chances of complications are 1 in 1000 for c section and 1 in 999 in VBAC, some women might still opt for the c section.

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There are 50+ OB practices in the metro area.

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nurse & mother – I don’t need to have been present at a birth that ended in UR to understand what one is. All births have risks. I am not anti-cesarea. I am against unnecessary cesereans and limiting patient choice (and if you do some checking into how few doctors in the US attend VBACs you will see where the “forcing” comes into it).

“So Christine…” – I never said I was more qualified than anyone. I urge everyone to do the research for yourself. The NIH panel that was just held (that I linked to above) is a great place to start. The National Institute of Health agrees that women are not getting the opportunity to VBAC or the risks of ERCS explained to them.

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Seriously…macho because I choose natural childbirth? Because I don’t hold my ultimate faith in my OB/GYN and would never consider suing for a delivery-related birth defect (birth is an uncertain process with NO guarantees). But I also believe that a birth experience exists, and having had a butthole for an OB who delivered my son. No, a c-section is NOT an option for me unless all other options are exhausted.

But since I’ve done this twice and am pregnant with a 3rd, it’s a subject I might know something about…

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Christine I am not convinced that you are not “anti-cesarea” (and certainly you are entitled to your opinion). So when do you feel that a doctor should tell a patient he/she refuses to let a patient VBAC?

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That was MAY NOT share his/her views.

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“This is not something that you decide at the last minute. On your first visit, you can ask the doctor if they are willing to give it a try.”

Well, I did ask, at the first visit, and at several subsequent visits, as I met the different OBs in the practice. And they were all “Oh yes, we are *very” VBAC supportive,” until my third trimester, when all the “ifs” and “buts” and various (non-evidence-based) cracks began to show in their alleged “support.” And the more they doubted and discouraged, the more I talked about research and statistics — and the less patient and friendly and “supportive” they became. And they forced me to be put on their surgical schedule for the week of my due date – and yes, I do mean, forced me to be scheduled, because they scheduled me without my knowledge or consent. I was not consulted as far as the date, time, nor the doctor(s) who would do the surgery.

I pointed out that there was no EVIDENCE to suggest I could not go past my due date and go into labor naturally, and I did not want to be scheduled before 42 weeks. So they did it anyway, and then pointed to their sign that said they would charge me a fee of several hundred dollars if I canceled the surgery.

Bait and switch… it happens all the time. I found a new doctor who *does* practice evidence-based medicine, and, thankfully, was willing/able to take me on as a patient, at 37 and a half weeks, and had a VBAC one week later.

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N&M, thanks for quoting my typo there ;)

When used judiciously a cesarean is a lifesaving procedure. I am certainly NOT anti-cesarean.

I do not think that a patient should ever be forced into surgery. The risk of maternal death is almost 4 times higher in a cesarean than in a vbac. That risk is not something that anyone should choose for the mother.

As I said before, I also do not think that a physician should be forced to attend to a patient that they are not comfortable attending if they feel the risk is too high. But how to reconcile the two?

One thing I know is true – if we can reduce the primary cesarean rate in the US, far fewer women and doctors will be faced with this conundrum.

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Every woman needs to work with her doctor to make the right decision for her and her baby. My doctor never forced me into having 3 C-Sections, he just gave me all the facts involved, both pro and con with having VBAC after having the first C Section. Part of that information is evaluating why you had the first C Section, and whether those risks of VBAC are still present with the second pregency or not. Both my “premium” babies are now 25 and 21, and I am very thankful that the technology for C-Section is now available. I wouldn’t have both of these beautiful, intelligent women in my life had it not been for C-Section delivery. Too long to explain why the first child was still born, and why my doctor chose to deliver them 3 weeks early on purpose, but I’m glad he did. Not only did we make that decision together, but he provided excellent prenatal care for someone whom at the time was considered “high risk”. But part of that was because I was involved with my care as well, it was my responsiblity to ask questions, each person needs to be involved in their own prenatal care.

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…is defined, by me, as a woman who is going to have that baby “naturally” no matter what the OB is recommending, no matter what the fetal heart monitor shows, and no matter how mnay red flags are staring her in the face regarding the delivery of her child. Then, when the problems exxacerbate, she still won’t give in, and when the child is compromised she claims that the OB / labor nurses failed to inform her of all the problems and it is THEIR fault.

Tonya, you may not fit this description to a T, and you may THINK you will not sue the OB, yet until you have that compromised child, you do not know what you will do…

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“Tonya, you may not fit this description to a T, and you may THINK you will not sue the OB, yet until you have that compromised child, you do not know what you will do…”

Good thing she has YOU, who obviously knows best, and can predict what her theoretical response to a statistically unlikely outcome will be.

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…”the theoretcal response to a statistically unlikely outcome” is not known until it is known – and by then, if you have made the choice that is “statistically unlikely” to happen, and it happens because the was adamant in being “macho”, the more likely she is to try to look for blame outside her own head…

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Ok, Jamie, it’s not rocket science. If you try to encourage more women to deliver vaginally with the first delivery (when POSSIBLE-remember fetal distress, placenta previas, breech babies just to name a few don’t qualify) instead of a c/s, then you are automatically going to reduce the number of c/s. To be put simpler: If you have a mother who has a c/s (and maybe the doctor rushed to the c/s conclusion) then she is most likely going to have a repeat c/s. BUT if you give women more time to try to delivery vaginally (when possible), you will probably have some who will deliver vaginally rather than c/s. I have seen a few midwife patients who ended up delivering vaginally where the doctor had already recommended a c/s. That said, there are still going to be many women who couldn’t deliver vaginally if you let them labor for a week. Do you understand what I am saying now?

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N&M I see what you are saying perfectly fine but it does not follow suit with what you are saying about VBACs. Yes more women should be given more time to deliver vaginally but many OBs won’t do this for fear of lawsuit if a bad outcome occurs (just like with VBACS and you have already said that doctors should not be forced to practice a way that will put them in danger of lawsuit). And you are saying you believe too many intial c-sections occur well then how does it follow to say very few people qualify for a VBAC (if as you said many c-sections are being done unnecessarily)? I’m saying your two different points make sense but the two points are not in line with each other.

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“macho woman” sounds like a grady nurse I know…which is why I will NEVER trust my care to Grady. You don’t know what’s best for me, and doctors don’t always either. I make sure I’m an educated consumer. Period.

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…NEVER say never – if you are in a knife fight, get shot, get 3rd degree burns, or in a really bad auto accident, the only ER in the Atlanta area to be taken is Grady if you really want the best care for traumatic injuries…

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Jamie that is because VBAC’s are different than a laboring patient in a first time mom. Yes, I think that there are some C/S that are done unnecessarily. Are all done unncessarily? Of course not (common sense).

Once a c/s has been done (whether it was done unnecessarily or not is completely irrelevant at this point) there are risks to VBACing (once again read my previous posts). Some women are in the low risk catagory (see above posts) and others who are at high risk. Sheesh!! I refuse to carry on a battle of wits with an unarmed person.

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N&M, I think the “high risk” part may be where you are losing some people. You haven’t really illustrated who you think is too high risk to vbac or statistics to show why you think so.

I really don’t see how personally attacking people is catching more flies with honey than with vinegar though.

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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?

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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.

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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).

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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 ;-)

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New Stepmom,No nurse can save you from Northside’s sky high c-section rate.

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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.

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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.

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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.

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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.

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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.

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@ Patricia, nervous is probably a better word than scared. Thank you for the well wishes even if we do not see eye to eye.

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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.

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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.

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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!

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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;-)

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Nurse&Mother–Why would you even mention that? It just seems like you are putting down doulas for no exact reason.

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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.

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And based on what I have read, it looks like something of a pissing contest has been going on all day.

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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.

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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.

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precisely why I don’t want another one, rocket scientist;-)

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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.

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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.

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“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).

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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.

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Yes, Gigi, it is an involuntary action. However, giving birth does not come without some MAJOR risks. I am a c-section baby, and I would be dead if not for a c-section. My first and third sons would be dead if not for c-sections. Are they used too much? Probably. Are they always unnecessary? Definitely not. Like I said before, if I get a healthy baby in the end, I’m happy. I didn’t have the whole vaginal birth pushing the baby out experience. Guess what? I really don’t care. I have three wonderful, beautiful kids. Isn’t that the goal?

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Irisheyes, NO one is contesting whether the goal is a healthy baby. I think that’s a rhetorical point that you, and others, keep making, and it has nothing to do what many of us others are saying. Women deserve the opportunity to labor and deliver their babies as their bodies were meant to do, and in today’s birth climate, both here in Atlanta and nationwide, that is not happening.

I have heard time and again women say ‘my c-section baby would be dead if it weren’t for my c-section,’ and you know what, some of them are probably 100% correct. But a vast majority of them believe that that is true because their OB told them so, and once they seek out what really happened prior to them landing in the OR, they discover differently.

How many women have an “emergency c-section for fetal distress” these days? Countless. How many of those women’s labors were augmented with pitocin, etc.? Countless…

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When I had my child 12 years ago, I went into delivery with zero expectations of how I would reach the end goal of a healthy baby. I didn’t plan on anything, though I did consider what could happen. If it was too painful, I knew I’d ask for an epi, if I or my baby were in danger/distress I would have a c-section, if everything went “perfect” so much the better. But as life is want to do, stuff happened. My labor was fast (4 – 8 cm in 30 mins), baby was “sunny side up” had depended, but I wouldn’t get past 8 cm, and baby would not turn over despite some fairly limber movements on my part considering the pain and my girth! End result was a healthy mom and a healthy baby delivered by c-section. Bottom line, you can plan, you can research and still the unexpected can happen. Be informed, no doubt, but also be prepared that the unexpected can and will happen so be open minded and willing to do what you have to for a good outcome.

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…are you a MD/OB, or did you just stay at the Holiday Inn Express last night?

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New Stepmom, you say you are not knocking the choices of others, yet you seem to dismiss the goals of those who strive for a more natural birth as being selfish trend-followers. Where is the “honey” in that? You also say that the process is not about you. Does that mean you won’t be getting the epidural, then?

Nurse&Mother has not backed up anything she says with any stats. Her words are not facts, they are opinions. It doesn’t mean she’s 100% wrong – but it also doesn’t mean she knows all just because her handle on this blog says she is a nurse.

What’s with all the challenges based on what someone does for a living, anyway? How do you know someone who is a stay at home mom isn’t also a nurse, physician, biologist, statistician? Or just knows how to read?? Someone is either and MD, or… what? A homeless person staying in a hotel?

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New Stepmom..I hope all goes well with the birth of your first baby..My nephew and his wife had a very bad experience with Northside when their first baby was born, so no one in our family will ever go back there..Again, good luck and best wishes..

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Reading not your thing huh? I never said that ALL dr’s do not read medical journals. I was in fact pointing out your insinuation that moms were ignorant and dr’s were all knowing was ludicrous. Still is.

And right, because my screen name is momto5+1, it means that I have more knowledge than ALL dr’s. Assume much? I don’t have to qualify my educational background for you or anyone else, but I have worked with pregnant and laboring women for 10 years so yeah clearly my own personal experiences is all I have to go on.

I didn’t regurgitate any info, simply referred to links posted. I’m sure the NIH has a vested interest in whether or not women birth via major abdominal surgery or vaginally. That makes perfect sense…..right! You may want to look into how scientific studies are conducted before you start spouting off about how statistics are “fixed.” The AIG books and VBAC studies are not even similar. Nice try though.

Lastly, VBAC’s are not “cutting edge medicine.” They aren’t some trendy new birth practice. Dr’s are choosing not to practice evidence based medicine when it comes to VBAC’s (and so much more), regardless of what the medical journals have to say.

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And a nurse and a dr are exactly the same. Practical experience is the problem. They have NO experience with VBAC’s when they choose not to allow them.

I can only assume that ignorance must be bliss or so many wouldn’t choose it.

And your profession is what? Troll?!?!

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…with the name calling – and I did not mean to infer that VBAC’s were cutting edge medicine – I was referring to Christine’s catch-all phrase that MD’s do not keep up with the ways of the world re: the current state of the various medical fields. But, you wrote ” I don’t have to qualify my educational background for you or anyone else, but I have worked with pregnant and laboring women for 10 years so yeah clearly my own personal experiences is all I have to go on”. So, because you have worked with pregnant women you know more than those who, as I said before, actually WENT to medical school, thus having a whole lot more than 10 years of “working with” – try hands on working on pregnant women – but in you mine, you still know more!

And, as I first said yesterday, I am not a troll, but a 30+ year med mal person, with graduate degrees and industry certifications and all that stuff, so I do write with more than a little interest and knowledge in this field, as I am required to keep up to date in many field of medicine, not just OB, though I am by no means proficient in any field of medicine – I leave that to the folks who actually went to med school and I ask their advice when I need info on any particular medical topic.

And your expertise, other than “mom” and 10 years of “working with” pregnant women?

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..what do you think “evidence based medicine” is, other than statistical analysis of what is reported around the world? And, I would not put too much stock The World Health Organization, unless you are one of those who believes the United Nations has everyone’s best interest as their primary agenda…

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“I can assure you, most private practice doctors in this area are far too busy to keep up with the current literature on VBAC. They have already made up their mind they are not going to do VBAC due to liability issues (NOT because VBAC isn’t a reasonable choice)”

And you know this because you called “most private practices in the Atlanta area”? You admit you only called “many”, yet you painted with the “most” brush…

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Medical school is not nursing school. Don’t be confused.

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…I apologize for attributing statements to you that you clearly did not say.

And, I was only replying to momto5’s request for my background – and, why would I lie – no I am not a lawyer (but I have worked closely with them for over 30 years); no, I am not a paralegal, nor an administrative assistant – just a working person who comes to work everyday at 6am, does my job, and goes home, just like most working folks. I just happen to work in the insurance field of medical liability claim management, so I have more than a little interest in this, and all topics on this site, that involve medical issues.

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Dear geez,
A calling campaign is nothing to deride. It is a very good method of learning about the policies of area practices.
In fact, our national organization called every hospital in the United States to determine the VBAC status of hospitals that had maternity services and news services often refer to our work when discussing the VBAC ban issue.
See here: http://www.ican-online.org/vbac-ban-map?filter0=**ALL**&op1=5&filter1
Yes, we picked up a phone and called.

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…83% of the VBC’s with your group was associated were successful – what about the “other” 17%?

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And that was one of the mis-attributed quotes.

“…83% of the VBC’s with your group was associated were successful – what about the “other” 17%?”

unless you know of a third way that a baby exits a mom, it would make sense that the other 17% were CBACs.

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My first two were born via c-section – the first because my doctor (that I blindly trusted) wanted to induce and my body wasn’t ready. The second because my labor did not move fast enough for doctor’s liking. They were awful experiences. My babies were sleepy from the drugs, I was separated from them for a distressing amount of time, my breast milk took forever to come in, I was in awful pain (because I did not want to further drug my babies or impair my already limited caring abilities) from using minimal drugs.

When I became pregnant with my third, my doctors (at one of Atlanta’s top hospitals) told me a VBAC was not an option because of the risk of uterine rupture. I was crushed. It wasn’t until I started researching that I discovered facts that told me that my baby and I were at much more statistically significant risks with each additional c-section than with a VBAC. I learned that even first time vaginal birthers can have a uterine rupture. I got in contact with a number of well-educated people and read a lot of scientific articles and determined it was a “risk” I was eager to take.

I found a doctor with ample experience in delivering VBAMCs, multiples, breech, etc and asked about his experiences and outcomes and methods. He in no way promised me a VBAC but he set my mind at ease that I would get and honest shot at it, and that he was capable of dealing with any issues that could arise, including diving into an emergency c-section.

My labor and delivery was carefully monitored and I had a successful and uneventful VBA2C. I did it completely naturally with the help of my husband and doula, because I wanted an unmedicated baby and a ready milk supply. I’m particularly grateful for the outcome because shortly after birth, we discovered my baby has a rare illness and I was able to immediately, and relatively painlessly tend to him in the NICU – something I could not have done after a c-section.

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New Stepmom, try not to be too nervous. Once the process starts, just try to enjoy it as much as you can!! I can guarantee that for every hospital in every city in the county, you will find folks who say they would NEVER go there, so take some of the opinions with a grain of salt! One of your reasons for going to Northside (if I read your post correctly) is that is where your physician delivers. You are picking the MD, not necessarily the hospital. It is the MD who decides if/when a delivery is progessing as it should, etc. Try to enjoy the rest of your pregnancy, even if it is being spent in bed! Once he’s born, you won’t have to worry about that any more! :o)

As for all of you spouting statistics, etc., what about real life experience on a day in/day out basis? Does that not account for anything in your mind?

I don’t believe N&M has advocated one way or the other. She has stated that yes, vaginal births are optimal, but not always acheivable. She has even stated that VBAC’s are OK too under many circumstances!

It’s definitely your decision to try for VBAC, and you should find a physician who is willing to try with you.

You can all talk about and show every statistic out there. Think of it this way though…what if YOU or YOUR child were a statistic on the negative side? How would you advocate from that point forward?

Something you should take into account from N&M’s perspective is this, she actually SEES this stuff every day! She deals with the good and the bad EVERY day. She isn’t just spouting statistics that are out there. She is basing her opinion on what she sees and knows! Does she encompass the entire country and world? No!

And to the converse, Christine and her company have seen many of the “good” things. I’d like to know what happens when their VBAC’s go bad? What kind of statistics do they keep for that?!

Until you have to fight for the life of the mother &/or child, I don’t think you can fully appreciate exactly what happens!

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In the 5 years that ICAN of Atlanta has been serving women seeking VBAC in the area, we have aided close to 700 women either through phone support, referrals, in-person support groups, and a very active message board community. In that time, we have not had any maternal or infant deaths or neonatal birth injuries directly related to a mom’s VBAC status. A very rare event, like uterine rupture is, is seen…. very rarely!!! It is something that most doctors see once or twice in their career. Even our most VBAC-friendly OB, who is a member of our organization, who does over 100 VBACs per year, has only seen 4 uterine ruptures in his entire 30 yr career, having supported over 1000+ VBAC mothers and delivered over 5000+ babies. And of those 4 uterine ruptures, one was in a mother with no history of prior cesarean! And in those cases, no babies or mothers were compromised. Immediate medical action ensured mom and baby survived. A uterine rupture is a medical emergency, but it does not mean automatic death for the baby if prompt action is taken and there have been no reported cases in the medical literature of a mother dying from a uterine rupture either…. however, each year mothers die from complications from their cesareans, usually due to hemorrhages or embolisms or thromboses. In fact the maternal death rate in the US is on the rise and part of it is attributed to the ever-increasing cesarean rate. And the more cesareans a woman has, the riskier each additional surgery is for her.

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…ladies, regarding the 83% success rate for VBACs – obviously I interpreted the ’success rate’ to mean that of the 100% who tried it, 83% were successful. Thanks for clarifying…

Maybe I do need to take a reading comprehension course; nah, being as old as I am I’m probably just starting in the first stages of dementia…

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… I was not very clear in my statement. What I should have said was that of all their clients (100%) only 83% of their actually tried the VBAC. They then clarified that the other 17% did not try the VBAC for whatever reason.

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No, they said that 100% tried, 83% had VBACs, and 17% ended up having repeat C-sections.

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What % of women who have had multiple vaginal births keep a youthful apppearance to their vaginas?

This information I would think would have an impact on decision making.

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No, I don’t know. And you make jokes, but it stands to reason that the appearance would change. Things would get stretched and what-have-you.

I am merely curious as to the changes one can expect.

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Half of all doctors finish in the bottom of their class.

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Wow! There are alot of emotions on this topic.

Having worked in hospital based OB for over 30 years, I have seen far more iatrogenic caused complications than natural cause complications. Not a week goes by that we don’t see several babies delivered by elective repeat (or primary) cesarean that end up in the NICU with breathing issues that causes painful procedures for the baby, disruption of bonding, breastfeeding and extreme worry for mom and dad. I had a physician tell me she would never have consented to elective cesarean if she had been informed that he might spend ANY time in the NICU caused by too early removal from her body.(elective @ 37 weeks). She was not in obstetrics and had been assured by her docotor that her baby was completely ready! I saw one last week that followed the guideline of “no elective procedures until 39 weeks without medical cause” and the baby (whose pregnancy had been dated by ultrasound very early on) was 35-36 weeks when he was pulled out of his mother’s abdomen and spent 2 days in the NICU trying to breathe.

There are risks to birth – period. It is up to the woman and her healthcare provider to discuss evidenced based information and the woman to make an INFORMED, non-fear based decision as to which risks she chooses to accept. If her doctor does not wish to offer VBACs, he/she needs to be up front and not try to use fear to coerce the woman to make a decision for surgery or pull a “bait and switch”. If I told my patients the same kind of outlandish information that some doctors tell their patients, I would have lost my nursing license years ago. (like the doctor of a friend who told her the uterine rupture rate was 40%!) .

The bottom line is we need to drastically decrease primary cesarean rate, go to a system where midwives assist healthy women to give birth and obstetrical surgeons are only used for complictions and help women to trust that their bodies work well in the vast majority of instances and we can help if they veer from normal..

If a woman receives the information and chooses to accept the risk of primary, non-medically indicated cesarean surgery, she has the right to choose it BUT her insurance company or medicaid SHOULD NOT be required to pay for it. When she has to pay $10,000-$15,000 out of pocket, I’ll bet she changes her tune.

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If you are local, Amy…you do have a choice. You just need a new provider.

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…yes,you have choices; you are also probably considered a HIGH RISK pregnancy, especially with advanced maternal age (hope you had the amniocentesis done) along with 2 prior c/s. As both momto5 and Elaine are very attuned to this process, please just follow their advice and make an INFORMED decision NOT predicated upon the ” I have always felt like I missed out by not having a vaginal birth. I would love to do it this time” thought process.

Good luck, and good health, to you and your 3rd blessing…

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I had a VBAC under the watchful eye of my very helpful obstetrician – after having to expend far too much energy and time during my second pregnancy to find a doctor who would even consider it. There are scientifically-based guidelines for assessing who is a good candidate for trying a VBAC, so a blanket fear of them is unwarranted. I wanted to give birth in a hospital in case complications did arise, for my baby’s and my safety, but then I trusted my doctor not to push for unnecessary interventions. Unfortunately that trust is eroded in many doctor-patient relationships. My child and I are fine, and I had a wonderful experience and a much easier recovery than after my previous Caesarean.

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Michelle–your experience may have explained mine (all 3 of mine). Thank you. All three were significantly late 1-3 weeks and good-sized (smallest one was 9 lbs. 3 oz.) babies with 24 hour labors and all kinds of troubles. Each time the doctor said, “Well, that baby is definitely post-mature! I begged for a c-section with my first (10 lbs) but the doctor “didn’t have the time–too many other babies to deliver–I’d just have to push it out!” When they pulled her out they thought her collarbone was broken, and my tailbone broke.

There are quite a few things I understand better now than I did then (I think there is a country song in there somewhere.)

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Why are MEN even posting. Really have you been through 34 hours of labor pain meds free? This will be my third c-section and I WISH i would have listened to my doctor when he told me at 8weeks preg with my first he highly rec’ed a c-section bc my pelvis was so small. My delivery bc an emergency bc i listened to other people tell me my doctor only wanted to make more money… turns out he was right from the begining. Thank goodness my son was ok, however he still has a scar on his upper lip from my pelvis bone (stork bite they called it) bc i tried for so long to have a vaginal birth. Listen to your doctor – believe it or not they PROBABLY know what is best:)

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The main reason NIH keeps getting mentioned is that they just held a VBAC Consensus Panel earlier this week and that is what the blog post was in response to. They actually called out ACOG for some language in their VBAC recommendations that contributed to the declining VBAC rate.

That is getting more into the politics of VBAC than the science, though. Which the NIH panel also addressed.

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“I have heard time and again women say ‘my c-section baby would be dead if it weren’t for my c-section,’ and you know what, some of them are probably 100% correct. But a vast majority of them believe that that is true because their OB told them so, and once they seek out what really happened prior to them landing in the OR, they discover differently. ”

@Michelle Frank, I’m going to be very clear. I WOULD be dead. My oldest son’s head was FAR TOO LARGE to come out. I labored for over 14 hours in every position known to man, and when he was finally born, his head had not even begun to mold. He would have never made it through the birth canal. My youngest son could NOT have been born vaginally. The bones in his skull fused in utero, so his head could not have molded to come through the birth canal (he has the neurosurgery scar to prove it). So, I am one of those who are 100% correct. I’m not against VBAC’s, and I firmly believe that women should have the choice. But, there ARE medical reasons for c-sections, and to scoff at that and say “if you really knew the truth” is asinine.

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irisheyes, Christine posted exactly what I would’ve posted myself had I gotten back here first. I wasn’t directing any tidbit of what I said exactly at YOU, so to take what I said and throw it back at ME the way you just did…now that seems asinine.

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You did not have a VBAC gone wrong. You had an unfortunate complication of a vaginal birth that happened to be after a cesarean.

The only risk that is specific to a VBAC is uterine rupture.

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actually a uterine rupture CAN happen on unscarred uteri (especially w/ the use of cytotec) but it’s rarer than how rare it is for VBAC. U/R can happen after a myomectomy as well, but still rare. What to me everyone SHOULD be worrying about is placental abruptions, because they can happen w/ little signs to show for it, until it’s too late. The risk rising significantly after a previous cesarean, and even MORE after multiple cesareans. Stillbirth and miscarriage risk rise as well after prior cesareans. Which is why I fight to lower the PRIMARY cesarean rate on top of fighting for the right to VBAC.

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obviously I meant *un*eventful delivery…

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yes, sorry , was reading that wrong…thanks!

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ack, if you don’t post that other long post i posted, can i have a copy of it emailed back to myself LOL

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You’re missing my point. I don’t doubt that the Erb’s Palsy was related to your delivery (and likely your doctor). My point is that it has nothing to do with a *VBAC*

You did not have a bad VBAC. You had a bad vaginal birth. That was also after a cesarean. But what happened to you could have happened with any vaginal birth and is not related to VBAC at all.

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Your birth wasn’t bad *because it was a VBAC*

Your child’s injury was not related to VBAC. The only increased risk that vbac has is uterine rupture. You did not experience a uterine rupture, therefore the fact that your birth was after a cesarean is irrelevant.

You had a bad VB that just happened to be AC.

As Michelle pointed out, when you are telling people your story, they may come away with the impression “VBAC is dangerous”. But VBAC is no more dangerous than a regular vaginal birth, and Erb’s Palsy is not a risk of having a scar on your uterus.

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mandapanda – I’m so sorry for your loss. What happened to you is the stuff docs don’t like to tell us when they’re pushing c-sections (especially planned c-sections for “big babies” etc). Every c-section increases a mom’s risk of uterine rupture, placenta abruption, placenta previa and placenta accreta, all of which can be deadly for mother and baby. EVEN IF YOU PLAN A REPEAT C-SECTION, you can suffer from an abruption or rupture before your surgery date (which, for the safety of the baby, should be scheduled no earlier than 39 weeks, in absence of an urgent reason – see March of Dimes for more info). For those who think VBAC is exceptionally risky, you should know you’re at risk of rupture just by getting pregnant again! It doesn’t matter how you planned to deliver the baby if you rupture at 33 weeks.

The same medico-legal climate that makes it so difficult to find medical personnel supportive of VBAC is what contributes to the high primary c-section rate. Until docs practice evidence-based medicine over fear-based medicine, USA will continue to rank at the bottom of industrialized nations for maternal morbidity (42nd in ‘09, down from 41st in ‘07). And if more c-sections were the answer, we wouldn’t be 2nd from the BOTTOM for fetal mortality among industrized nations.

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2 if by C-Section – Unfortunately, there are a lot of things you were told that are wrong. First, when a baby is breech, it is safe to try to turn the baby (called external cephalic version). My doc turned my baby once during my pregnancy. I’ve known other women who had it done multiple times. If the baby remains breech, frank breech can be delivered safely. The Canadian version of ACOG recently reversed its recommendation that breech babies be delivered by c-section and now recognizes that vaginal delivery is safer (see http://ecochildsplay.com/2009/06/19/vaginal-birth-better-for-breech-babies-says-canadian-doctors/). Of course, that’s only if your provider knows how to do it. Regarding your VBAC attempt, it is unlikely you would have had to have been knocked out if you needed a c-section. If it was a concern, you could have had an epidural in place just in case. For my emergency c-section, they still had time to do a spinal, even though the baby was experiencing decels. It’s pretty rare that they need to completely knock someone out, especially when they plan ahead for it. Furthermore, your doc neglected to tell you that it is normal for a uterus to thin out during labor and they can look translucent at delivery.

You wrote, “My 2nd four years later, my Dr. and I agreed I would attempt a VBAC, though he encouraged me not to.” You later say your doc had your best interests at heart. He clearly did not support VBAC so is it any suprise that he only “let” you labor for “several hours” and then scared you into making a decision by threatening you with being knocked out? Was your baby in distress? Did anyone encourage you to get out of bed to help the baby drop? Did he discuss augmentation to help get things going?

With my successful VBAC birth, my labor stalled at 3 cm for several hours. I had been leaking amniotic fluid for hours. My doc then augmented my labor with pitocin, starting as low as possible and upping it only until my contractions became regular. I delivered 4 hours after starting pitocin, dilating the final 7 cm in that time.

I’m not trying to pick on you, but rather to point out how the same situation could have been handled differently with a TRULY supportive provider. It is hard to make an informed choice when doctors withhold pertinent information or use scare tactics to get their way.

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Let me first clarify that I am NOT anti-cesarean. I am grateful that the procedure is available and that both mom and baby almost always survive. This was not the case until fairly recently in history, and is still not the case in some areas of the world. And there are definitely cases in which a C-section saves the life of mother, baby or both.

The real problem, to me, is the current lack of true informed consent, and of the ability to make a reasoned choice.

I have been a prospective VBAC patient twice. Both times I was required to sign a waiver stating that I understood choosing VBAC could result in uterine rupture, hysterectomy, need for transfusion, infection, and even the death of the baby. Honestly, these can be pretty scary forms. They state the horrible things that *could* happen, but they do not mention the actual risk rates nor do they put them into perspective. Frankly, I doubt those who choose an Elective Repeat C-section (ERCS) receive a similar consent sheet listing the risks of choosing a C-section. I hope they would, but I get the feeling their consent is more along the lines of the general hospital consent – basically “as in any procedure, there are many possible complications but they cannot all be listed here on this form – ask your doctor if you have any concerns.”

During my third pregnancy (second prospective VBAC) I had read enough from the medical journals to know that those things listed were all possible with ERCS as well. This was also the pregnancy in which the doctor was less supportive and kept emphasizing the risk of hysterectomy from a failed trial of labor. The doctor, however well intentioned, was misled. The risk of hysterectomy in a VBAC attempt is not any higher than the risk in a ERCS – in fact, many studies have found slightly more cases of hysterectomy in ERCSs than in VBAC attempts. But my doctor had not read those studies – he was going off of his own impressions. And he honestly thought more hysterectomies occurred in VBAC attempts.

A few months later I called a hospital in the ATL area to ask about their policy on VBACs. The nurse I spoke with said the hospital completely banned them because of the high risk of uterine rupture. During our conversation, she kept stressing “the high risk of UR.” When I finally asked her what she thought the risk was she responded, “Well, they used to say it was 40% but now they’re saying it’s even more.” She was wrong. No study has ever listed the risk as 40%. The highest I’ve ever seen was no more than 12% and that was specifically when cytotec was being used to induce (a big no-no for VBACs and dangerous for even those with no previous uterine surgery). ACOG actually listed the rate as more around 0.8% in their 2004 guidelines. Do I think she was trying to lie to me? No. I think she really believed the rupture rate was that extreme. She just didn’t have the right information.

So a major problem is that usually neither doctors (or nurses) nor patients know the real risk of the “bad outcomes,” nor are they then able to put those risks into perspective.

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–Additional long-term risks—

C-section delivery is associated with higher rates of placental abnormalities in future pregnancies, and the rates increase with each progressive C-section.

Placenta previa (where the placenta covers the cervix), for instance, has a rate of 900 after one C-section, 1700 after two, and 3000 after three or more. This may not seem like a big concern if you were planning a C-section anyway, but previas increase the risk of hemorrhaging, hysterectomy, and accreta (placenta growing into/through the uterus) – even when a C-section is done before any labor starts.

And looking at the chance of the placenta growing into/through/past the uterus alone there is a risk of 319 after one C-section, 570 after two, and 2400 after three or more. These are pretty scary risks that would occur in pregnancy (so it wouldn’t matter if the mother wanted a TOL or ERCS for that pregnancy) and most of those rates are more than the risk of UR in a TOL.

Also, a prior C-section is associated with increased risk of abruption (placenta detaching from the uterus), chronic pain, ectopic pregnancy, stillbirth, and infertility, though it is not clear if these risks increase with additional C-sections.

Other problems that do increase with each C-section include clinically significant adhesions, complications during a future repeat C-section, and bowel and ureteral (like bladder) injuries. And, ironically enough, some women also experience pelvic floor disorders even if they have had only C-sections.

The bottom line is that these future risks should also be taken into consideration if a mother would like children after the current pregnancy. According to ACOG’s 2004 VBAC guidelines this should be considered if the mother is even 10-20% certain that she would like another child after this one – so basically if she is even considering the idea.

So again, there are risks to both choices. In fact, no pregnancy is risk-free, no matter the choices made. This is the information women and their providers should have access to when faced with the VBAC vs ERCS decision.

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GOOD JOB CASSIA! And i’d go further…not just a 10-20% certainty they want more kids in the future, but….every form of birth control/sterilization has a failure rate..even tubals and vasectomies. how many of us know women w/ “v-babies” or “tubal babies” or “my birth control failed babies” etc etc…. I know this seems far-fetched…but even these women are at risk from those placental complications and uterine rupture in subsequent pregnancies…. this is why we MUST fight to get the cesarean rate down! This is a human rights issue!! women and babies are dying!

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