College of OBGYN: Stop forcing women to have C-sections!

The pendulum is swinging back yet again and the American College of Obstetricians and Gynecologists has recommended that most women who have had C-sections, and even those who have two, should be allowed to try labor with their next baby!

We discussed in March on this blog the possibility of this guideline reversal and you guys felt very strongly about it. We had more than 240 comments on the story.

Here’s what the Associated Press reports about the new guidelines:

“Fifteen years ago, nearly 3 in 10 women who’d had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.”

“Last spring, a National Institutes of Health panel strongly urged steps to reverse that trend, saying a third of hospitals and half of doctors ban women from attempting what’s called VBAC, for ‘vaginal birth after cesarean.’”

“The new guidelines declare VBAC a safe and appropriate option for most women — now including those carrying twins or who’ve had two C-sections — and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.”

“Women’s choice is ‘what we want to come through loud and clear,’ said Dr. William Grobman of Northwestern University, co-author of the guidelines. ‘There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making.’ ”

“Overall, nearly a third of U.S. births are by cesarean, an all-time high. Cesareans can be lifesaving but they come with certain risks — and the more C-sections a woman has, the greater the risk in a next pregnancy of problems, some of them life-threatening, like placenta abnormalities or hemorrhage.”

“The main debate with VBAC: That the rigors of labor could cause the scar from the earlier surgery to rupture. There’s less than a 1 percent chance of that happening, the ACOG guidelines say. Also, with most recently performed C-sections, that scar is located on a lower part of the uterus that’s less stressed by contractions.”

“Of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section after all, because of stalled labor or other factors. Success if more likely in women who go into labor naturally — although induction doesn’t rule out an attempt — and less likely in women who are obese or are carrying large babies, they say.”

I like the doctor’s point that the new guidelines are all about giving women the choice! If you aren’t comfortable trying to push and are worried about popping your incision then have another C-section. But if you want to try labor and pushing, then go for it.

So what do you think: Would you want to try to have a VBAC? Are you glad to have the option? Do you think it’s a worthwhile goal to give more women the chance to give birth vaginally? Does it really matter how the baby comes out? (I do believe recovery time and sometimes safety it does.) Do you wish you have been given a choice — which would you have chosen?

(Check back at 2 p.m. for a second topic.)

52 comments Add your comment

[...] This post was mentioned on Twitter by educationfinder and AJCMOMania, Caroline Porter. Caroline Porter said: Hey I found this! College of OBGYN: Stop forcing women to have C-sections!: The pendulum is swi… http://bit.ly/9UN3vZ I hope this helped! [...]

Andrea

July 26th, 2010
7:40 am

I had a VBAC with my second. It can be done. I am sure in some cases there are medical circumstances that could prevent some women from having VBAC. But, there are women who choose C-sections for non-medical reasons (convenience, not wanting to go through extended labor, etc.). Those types of operations should be stopped.

motherjanegoose

July 26th, 2010
7:50 am

We have discussed this before and this topic annoys me. I will not argue with those who believe VBAC is the way to go, yet have not had a child who has been injured due to a VBAC delivery.
I also do not know Moms ( personally) who were in outraageous pain due to a C section and had a long recovery. To me, the pain from a C section would have been a trade off for the mental anquish
( sp) from the VBAC but I have not worn the shoes of having a difficult C section. I have worn the VBAC gone wrong shoes.

I have 2 children…one with a C section ( perfectly healthy) and one with a VBAC and a birth injury. She has it documented in her file that her range of motion in her upper right arm is ******forever****** limited due to a birth injury ( Erb’s Palsy) . See this link:

http://orthoinfo.aaos.org/topic.cfm?topic=a00077

This was a result of a VBAC delivery and will not be able to participate fully in several activities.

Yes, it is about choice for the mother. To me, it does not matter how the baby gets here…as long as both mother AND child are healthy and you are involved in the choice. I was not involved in the VBAC choice, I would have chosen another C section, as my daughter was nearly 9 pounds ( no I did not have gestational diabetes) and I was in Labor for over 24 hours. I begged for another C section and no one listened. I had two different doctors ( son/daughter) and the second one was not looking after our best interest. My daughter will carry this with her the rest of her life.

Yes there are risks with C sections too. Be informed and do not let your Doctor railroad you. Choose what is best for YOU but be informed. Opinions are like noses…every one has one. Make sure the opinions you listen to are provided by someone who has YOUR best interest in mind. All situations are different and are YOU willing to live with the outcome if things do not go like they should in the textbook, or others here will tell you. It is your body and your baby. Some VBACS
( not mine) or C sections ( mine) proceed in a fine fashion…be informed. Who will be by your side when things fall apart? Either choice is a major one with consequences. Know your options.

motherjanegoose

July 26th, 2010
8:04 am

On a follow up, from another blog. I want to recommend Physician’s Immediate Med of Buford, GA.
this is where we ultimately obtained our Varicella and Meningitus ( sp for both) immunizations ( for my daughter) . it was great to get this done after I mucked through several other ( non successful) options that did not work and we are on a deadline for UGA. Michelle ( on the blog) recommended this location to me and after checking with our insurance provider…the entire visit was fully covered. A great place! They were very efficient and kind. They are open most days and take walk in appts. Plus they accept various types of insurance. They have other locations too. Something to know, if you have a medical issue when your Doctor is not in.

I have also run the ridiculous story about the fee , to get the shots at the Health Department , by several others. Everyone I talked to, including a nurse at Kaiser, thought it was absurd. I did not hear one time:
“Oh yes, it makes absolute sense to charge those with no insurance $14 for the vaccine ( you need) and since you have insurance…you should pay $113.” I did hear, ” UMM we are the ones paying taxes for the health department and we have to pay that much more to use it…that is crazy!” Guess I run in the circle of those who are tired of paying taxes ( for others to have things) and also paying for all of our own things.

A neighbor told me about a family at Wal- Mart who had a counter full of things they paid for with WIC and Food Stamps. Then. the second part of their order included chips, snacks, beer and cigarettes. They drove off in a brand new Ford Expedition with a dealer tag on it…oh yeah, they probably won it in a raffle last week….LOL.

motherjanegoose

July 26th, 2010
8:07 am

T my 2nd comment is lost….I wanted to share some medical information that would be useful.
Can you find it?

newblogger

July 26th, 2010
8:40 am

I had a “VBAC gone wrong” as well. I went into labor a week early with my second child and my doctor asked me if I wanted to try a VBAC since I was already in labor. I thought why not? According to ultrasound this baby was not as big as my first and I wanted to try it. Bad decision! I was in labor for 16 hours, after which my temperature spiked really high and he ended up being an emergency C-section. I had a different doctor from who I had with my first and my boys are 10 years apart. After it was all said and done, my doctor said that if I decided to have another one(no, but thanks for asking) it would be a scheduled C-section because of the way I’m built inside. (I will spare you the details.) I think it should be up to the mom and her doctor to decide. I really don’t have a problem with C-sections for non-medical reasons either. It certainly isn’t my business as to how someone wants to go through childbirth. I didn’t have a long/hard recovery with either of my C-sections. The only fault I have with them is that there is a part of my lower stomach that no amount of situps will render flat, but that’s a discussion for another day. I wanted to have a VBAC so I could experience a “normal” childbirth but it just wasn’t meant to be. Looking back, it doesn’t matter how they got here-just that they got here safe and sound.

DB

July 26th, 2010
9:05 am

I think that it’s a given that childbirth can be hazardous to both mother AND child, no matter if it’s a C-section, natural, or whatever. There is always the propensity for things to go wrong either way, so to say that one way is “better” than another does not take into account the circumstances that the mother and her doctor are faced with AT THAT MOMENT when a decision has to be made.

My first was an emergency C-section, after 40 hours of labor. Eh, it happens, and I’m not going to Monday-morning quarterback the doctor at the time, because every step of the way, I agreed with his reasoning, up until that moment he said, “I think we’re looking at a C-section” (at which point I heartily agreed!) I will say that that I was not one of the lucky ones who bounce back from C-sections — in fact, two weeks afterwards, I could barely make it to the mailbox and back, and it was a good six months before I felt anything approaching my old self. That was MY experience. My second was a very successful VBAC — albeit it was a VBAC with lots of doctors standing by “just in case” it didn’t progress as it should. Compared to the C-section, I was bouncing around in a couple of days. So my personal prejudice is to at least give a VBAC a try and see how it goes.

I don’t think there should be any hard and fast rule as to whether a VBAC is a good idea or not. It depends on the mom, the baby and the doctor. If someone wants to try a VBAC, I think they should be supported. If they don’t, then schedule accordingly. The important thing that is that both mom and baby have an optimal experience.

pws

July 26th, 2010
9:07 am

There are a lot of folks on this blog who don’t like you MJG, but this time you are right on the mark! It’s all about your involvement, and your choice, so make an informed choice! I had three C sections, the first one because I had abruptio palcenta at 6 months. All the bleeding was internal, and the doctors told me that had I not had the C section to stop the bleeding, I would have died along with the baby. Our daughter died instantly, and I can remember what that excruciating pain was like that morning, even though it was 26 years ago. I had two pints of blood, and it still took me about two months to get my blood count back to normal.

With our oldest living daughter, I had 37 prenatal visits, and my doctor and I got to be good friends. He delivered her three weeks early on purpose, and she was healthy. We were so thankful to have a healthy child. With our second, four years later, my same doctor told me that it was my choice as to whether or not I wanted to try the Vaginal route, but that he hoped that I would decide to have the C section, and have her delivered three weeks early as well.

I decided on the C-section, and was glad I made the right choice. Long story, but afterwards my doctor told me she would never have made it vaginally, and he was thankful I had made the choice to have the C section. Both my wonderful girls are now beautiful adults, the first has graduated from college with honor and is a mechanical engineer, the second is starting her senior year of college and will graduate in 3 1/2 years with highest honors. She is applying to medical school this summer for the fall of 2011. I tell them both how special they are, and if not for C sections would not be here today. Thank you that we have a choice, and all mothers should be able to be informed and have that choice!

Becky

July 26th, 2010
9:09 am

I had a C section with my first because of a breech baby…my second was a VBAC….so much easier!!! But you have to have an encouraging doctor that is willing to do the VBAC! I highly recommmend the VBAC if the conditions are right.

Amy in the ATL

July 26th, 2010
9:14 am

I’m all for choice, but I do think people need to realize that most women who end up with C-sections don’t do it for “convenience” but rather out of concern for their and their child’s well-being. Obviously a vaginal delivery is much more natural and preferred, assuming there are no other circumstances. But for those of us with circumstances raising the risk of a vaginal delivery, a C-section is a God send. Don’t forget that in the days before this was an option, one in four women died in childbirth. And the stillborn rate was much higher, too.

In the end, this is a decision between the mom and her doctor. Everyone should be informed and make their own call. If a mom wants to try a VBAC and she can, she should have that option. But when things aren’t going right, it’s great that we live in a place and time when we have a surgical option.

A

July 26th, 2010
9:16 am

A woman can do anything with her body that she wants. She can abort, have the child vaginally (big owie there) or have a c-section. It’s not political. It’s just what the mother wants. I really wish women would stop being so judgmental about this. A pregnant woman will make her decision after she has listened to the facts. It’s an individual choice. Women are so hard on other women. Is this because they have decided that childbirth is the only arena in which they have power? Childbirth is a lovely thing. How it’s done is no ones business.

One here, one on the way

July 26th, 2010
9:17 am

My first baby was a C-section baby five and a half years ago due to breech presentation, and I’m currently on the fence about whether to have a repeat C-section or try a VBAC with Baby #2, due in October. I keep waffling back and forth. I’ll be reading today’s blog with great interest.

motherjanegoose

July 26th, 2010
9:20 am

@ DB…good points.

Both types of deliveries certainly do have their downsides. I was vaccuming ( sp?) the entire house after 1 week and my C section. I was also at Wal-Mart shopping , in less than a week, and my neighbors saw me…their mouths dropped open. I was getting around just fine by myself. No issues for me. I was back to work in 3 months.

On the flip side, I was crying for months after my VBAC, looking at my baby with an arm that was limp like a piece of spaghetti and pinned to her onesie ( so that it would not get wedged behind her in her car seat as she could not move it herself…there was no arm movement as the nerves were damaged).

It IS up to the patient and we all need to know that each situation is unique and BE INFORMED. Read up on everything and know where you are headed….before you are faced with the options. Talk to a labor and delivery nurse. It IS the mother/child who will ultimately deal with the outcome…not the Doctor who may have coerced the decision.

Many VBACS and/or C Sections are completed with no complications and the goal (to me) is to be one of those statistics!

Lauren

July 26th, 2010
9:25 am

Im a pediatric resident-VBACs can go right and wrong. When they go wrong, they go TERRIBLY wrong and the babies have the potential to suffer irreversible brain damage. I would advise any of my friends to not try VBAC. I guess personal experience has spooked me

JATL

July 26th, 2010
9:26 am

I’m all for trying VBACS unless you have a documented medical condition that shows it’s a bad idea. I DO agree that it should be a woman’s choice to a point, but (I hate to say it) I know MANY -yep -not just a few -women who have taken their doctor’s leaning toward a C-section and run with it because they didn’t want a baby to come out of their vaginas. Several have asked if they could have one for no medical reason, and their doctors have complied (more money for them, and I think medically irresponsible). Immaturity and silliness of this nature make me want to scream. I’ve talked to many of these women about the fact that having your belly cut open is usually much worse, but it’s a mental thing with them. For that type -it makes me angry that they’re basically having c-sections they don’t really need.

I do know a number of women who have recently had very successful VBACS, and I highly urge others to do it. I know some people have issues where it’s just not a good idea to try it, and that’s fine, but I would love to see the medical community back off of being so c-section happy.

motherjanegoose

July 26th, 2010
9:33 am

@ pws…thanks for the laugh:

pws

July 26th, 2010
9:07 am

There are a lot of folks on this blog who don’t like you MJG…but this time you are right on the mark!

To me, the reason folks probably do not like me is because they do not agree with me and think I am crazy.

Today, you agree with me as you have “been there done that”. There will be others who will disagree with me, as usual. They have not been in our shoes. We have not been in their shoes either.

I have seen and experienced some things that others have not, while others have done things I will never know about. I share my opinion and that is what it is…if anyone here does not like me…oh well.

There ARE lots of folks in 50 states who DO like me and even a few on the blog who have met me in person! We continue to stay in touch and have become friends through the blog. Not sure how many others have actually taken time to meet one another and see the person behind the name ( on this blog) . It is lots of fun!

Oh, BTW I have now been invited BACK to Montana as my reputation is out in that state too. HHHMMMM I do not know everything but I do know about 5 things….LOL.

psv

July 26th, 2010
9:36 am

Enter your comments here

motherjanegoose

July 26th, 2010
9:39 am

T…2nd comment today that did not post…I just sent it after JATL @ 9:26. Where is it?

Thanks Lauren, you provide a medical perspective that I could never provide.
Personal experience has also spooked me!

@ One here…pay attention and make an informed choice for yourself and your baby.
Know your options on both sides. If it were me, I would try to see if Lauren would be able to get in touch with you and share some insights…perhaps how long should you try for a VBAC to see if it would be a good option. ( sometimes T will connect you with another person’s e-mail if both parties are willing)

Good luck!

Erica

July 26th, 2010
9:40 am

It is up to each mom to be to weigh her OB’s advice and decide whether a VBAc or repeat C-sction is best for her. I agree with Army in ATL on her comment that most moms don’t arbitrarily choose a c section for convenience (although that is also up to a mom and her OB), but it is normally done for the health of baby and/or mom. My baby was delivered via c section almost 5 years ago due to her size and my asthma complications during the pregnancy. My recovery was pretty decent and more importantly, my little girl came out big, but healthy! Would I do a repeat c-section? If we are fortunate enough to have baby 2 (at the ripe old age of 40-still hopeful), then this kid will come out via c-section as well. Hats off to all moms who chose a VBAC, but I’m taking NO chances, if we are blessed enough to have a successful term pregnancy at this point!

psv

July 26th, 2010
9:48 am

I have had 2 children, 6 years b/w them and I should have had a c-section with both. The first heart rate dropped really fast, cord around her neck. The doctor ended up using the suction apparatus and she was grayish blue & not breathing when they got her out but they got her breathing a minute later and she is a healthy, strong 9 year old. No problems at all physically or mentally. The second time my blood pressure dropped significantly after the epidural, I have a bc of low bp. I had to be stabilized but they let me deliver vaginal anyway. She was stressed in her breathing for the first few minutes but she stabilized. She is fine as well. Thank God for bringing us through all of that and if there is third baby it will be a scheduled c-section. I don’t want to risk my health or the baby’s.

omom

July 26th, 2010
9:49 am

My doctor’s office really pushed for vaginal delivery and though I had been told by many friends they preferred c-sections personally and found recovery easier, I prepared for a “normal” delivery, I took all the classes and was excited and ready (though I made it clear I was fine with a c-section if needed.) I was almost 43. I ended up having to be induced when my water broke without me going into labor. The next 28 hours sucked! Nothing went right, halfway through the experience I asked if I could just have a c-section but the doctors wanted nature to take its course. Finally the baby became distressed and I got an epidural and was wheeled in for a c-section after being awake, in pain, and without food or water for over 30 hours, covered in vomit. When my baby came I was almost too weak to hold him. The surgery was a breeze and that part of the recovery was sooo much easier than I expected. What was difficult after the birth was recovering from the difficult labor and feeling so exhausted and weak from that. If I had just gone in rested and prepared and had the c-section, the first 3 days of being a mother would have been much more enjoyable and special. I also have had less lingering recovery issues than some of my friends who had vaginal births. My main wish is that my doctors had been more open to my wish for a c-section and we could have avoided all the many complications that arose. I am too old to have a second baby, but if I did there is NO way I would not have a c-section.

motherjanegoose

July 26th, 2010
10:00 am

Per my first entry:
I apologize to DB, I do know her personally and she did have a Csection problem. Sorry.

Just Me

July 26th, 2010
10:18 am

TONS of women have c-sections for convenience & because their husbands don’t want their vaginas stretched out :neutral: I ONLY agree to have them IF there is a medical reason..

Theresa Walsh Giarrusso

July 26th, 2010
10:39 am

MJG — I will find it — I just want to say I am not pushing women to have VBACS — I am reporting that the College of OBGYN is saying you don’t have to have another C-section unless you and your doctor feel it is best. Does that make sense — the point is you can make a choice and a standard that doesn’t make sense for you isn’t going to be forced on someone –

Theresa Walsh Giarrusso

July 26th, 2010
10:46 am

found them — they should be there

Michelle

July 26th, 2010
10:56 am

I find it interesting that not too long ago it was the “standard” once a c-section, always a c-section. That practice came up against so much resistance from many sources. I think making it more of an “option” versus a requirement can make the mothers feel more at ease.

Unless I had to face the situation, I cannot say what I would do. And at 40+, I really don’t see me having any more! :o) At least I sure hope not!

DB

July 26th, 2010
11:05 am

@mjg – no offense taken, hon. Given your experience, I’d have been a bit spooked, too! I can just remember shuffling out to the mailbox (50 yards away) a couple of weeks after the C-section, and having to hang onto the mailbox, gasping in pain. And I’m someone who doesn’t bother with aspirin unless I’m blind with a headache! I have always found it intriguing that people will promote C-sections as “safer”, given that it is major surgery, slicing into your stomach and uterus. How that can be “safer” than a natural childbirth is beyond my comprehension, assuming all other things are normal.

Having said that, I’m with a previous poster – thank goodness we have the option available, to insure the best possible outcome for mom and baby. I look at my now-21 year old son and it’s hard to believe that if we were in 1888 instead of 1988, we would probably both have died in childbirth.

motherjanegoose

July 26th, 2010
11:37 am

@ T…no problem on my end. Each women should check out all the facts and make an informed choice. Thanks for your comment though!

I present lots of advice here, based on my experience. Others do too. An intelligent person will mull over all information presented. As I have said repeatedly, we are all on a different sidewalk and have had different experiences. DB and I agree on a lot of things ( that we have discussed). This is one scenario where we had different experiences and since we are both reasonably intelligent (she is WAY more intelligent than I am and I have told her so :)…) we can agree that either option is not perfect for everyone!

Outta hear to record a new CD…have a great afternoon all!

HB

July 26th, 2010
11:52 am

MJG, did the people you spoke to about the immunizations realize the health department and many doctors’ offices are participants in a federal program designed to give free immunizations (with up to a $14 admin fee that can be charged by the provider) to those who haven’t already paid for the shots elsewhere (as those who have paid for insurance that covers immunizations have done)? I just still don’t understand — why do you want the government to cover a shot that your insurance policy already covers? What could possibly be more wasteful than spending tax dollars to cover those who already paid for coverage somewhere else?

motherjanegoose

July 26th, 2010
12:15 pm

HB, I do not know but MOST of the folks I spoke with were nurses or worked in a hospital scenario…one would think they would know. Maybe not?

I went to the health department because my provider suggested it, as they did not have the immunizations I needed in their office. Perhaps they know I have insurance, as they are my primary provider and the ones who typically file my insurance to get paid?

I have not been to the health department in YEARS. I thought I remembered that they used to have a sliding scale based on income. I guess I do make 100% more than those who may not be employed and so I would pay 100% more? I went to the HD as a last resort, since I needed the immunization and was told ( by the nurse in our practice) to go to there.

THE CLERK AT THE COUNTER TOLD ME THAT SHE AGREED IT WAS NOT FAIR BUT THAT WAS SIMPLY THE WAY IT WAS.

Everyone I spoke with was surprised by the fee associated. We all learned something we did not know.

Oh, I am certain that there are lots of things more wasteful than providing a required college immunization for a student who needs it ASAP to proceed with registration.

One example my son mentioned, was a patient who filled prescriptions for ACNE medication…the true cost is $600 for a tube and they have Medicaid, so it is not $600 for them! Let me just share that I could not afford a $600 tube of ACNE medication each month ( or my co pay) and we would just have to tolerate the ACNE.

Or how about the lady who tried to buy dog food with FOOD STAMPS, while we were at the register. The clerk told her it was not allowed. “Well, she says, I guess my dog will just enjoy a roast then”…and she came back with one from the meat counter…paid for by our tax dollars.
TRUST ME ON THIS ONE…our dogs do not enjoy their own roast….anyone else?

We are on different sides of the fence on this one and that does not appear to be something that will be resolved. Others here, have seen what I have seen ( mentioning it on the blog) and perhaps there are others here too who agree ( with you) that our government is certainly doing the best job of taking care of those who absolutely need every bit of aid they receive. Using all tax dollars in a most efficient manner. Perhaps we will hear from them today too!

Now, I am truly out the door for the next several hours….LOL.

Tammy

July 26th, 2010
12:19 pm

I tried VBAC with the birth of my second child. Result, emergency C-Section, ruptured uterus, both of his almost died, me from the loss of blood, her from almost drowning in the blood from the rupture. Luckily we are both alive and well. Would not recommend to anyone. Doctor took no responsibility, imagine that.

JATL

July 26th, 2010
12:27 pm

@MJG -I’m with you on the health department and WIC/food stamps, etc. As far as I’m concerned, I should be able to walk into ANY health department and get shots or birth control for free since I pay a lot of taxes! I also think that WIC/food stamps should have to go to a certain grocery line where the purchases are monitored closely. I’m a big advocate of, “If I’m going to pay for you to eat and have kids, then I get to dictate what you’re eating.” If you don’t like it -get a freaking job and quit breeding! As far as anyone with pets on food stamps -get some priorities! I love animals and pets, but it should be a qualifier for food stamps that you cannot own one! I had much rather see more of my tax dollars go to spay,neuter and vaccinate animals and have more no-kill shelters than to keep propping up lazy breeding machines. Funny how they all seem to know exactly where to head for food stamps, but they can’t seem to find their way to the health department for free birth control!

joann

July 26th, 2010
12:39 pm

ok motherjanegoose———-Let Someone Else Talk.

HB

July 26th, 2010
12:39 pm

“Oh, I am certain that there are lots of things more wasteful than providing a required college immunization for a student who needs it ASAP to proceed with registration.”

But you’re asking the government to provide a SECOND immunization! You already paid for your own insurance to cover one, but are asking the government to pay for an additional shot, because you decided the insurance-covered one is inconvenient and don’t want to use it. Seems to me, your complaint should be with your insurance company for refusing to reimburse you if you go to the health department instead of a network doctor’s office, but instead, you want tax dollars to pay to make things more convenient for you. Talk about a sense of entitlement…

Does anyone actually read the underlying story before commenting

July 26th, 2010
1:01 pm

ACOG’s new guidelines say only that VBAC can be a safe alternative for some women, whereas the old guidelines advocated against not having a VBAC. There are many doctors and hospitals who refuse to treat patients seeking a VBAC and offer no alternatives. The new recommendations are based on more recent studies that show that in many cases, a VBAC is a safe and healthy alternative for moms and babies. Its all about choice and providing women and their doctors with options. Most people (and certainly doctors and nurses who practice on obstetrics) can point to horror stories of women with vaginal births, women with c-sections, women with VBACs and women with repeat c-sections where things have gone terribly, terribly wrong. That doesn’t mean that any one way of giving birth is right or wrong. All it means is that a woman and her doctor should discuss what’s best for her based on her personal desires and her medical situation. There’s really no reason for anyone here to conclude that a particular way is the “right” way as each person’s body, experience and medical status is different.

Michelle

July 26th, 2010
1:01 pm

HB…it’s not that MJG didn’t want to get it from her doctor’s office…they do NOT keep that immunization there! It had nothing to do with convenience! They had already charged the “service” fee so she could not go back in to get it at another time…billing is a whole world all in its own!

Here’s my beef about the health department. Yes, some people have insurance that covers immunizations, HOWEVER, if they do not wish to actually see a physician, etc. why should they have to when the health department has them in stock? Why does it matter if you pay the “standard” fee that everyone else does? It seems to me that our taxes have paid into it AND paid for an additiona vaccine (instead of free) on top of it?!

I can assure you that MJG is not the only one that has encountered this problem! It is WAY more widespread than it should be!

I will have to say, it is very difficult to get “everything” you need these days at one time. Not all schools/physician offices are on the same page when it comes to college admissions!

Erica

July 26th, 2010
1:13 pm

What this article does seem to emphasize is the importance of a mom to be and her OB having a good trusting relationsip, where the OB listens to the mom’s birth choice, but is also able to advise her medically of all alternatives available to her based on her health situation.

cobbmom

July 26th, 2010
1:13 pm

I am glad to hear this may once again be a choice for women. How someone experiences that special moment of birth should be their choice. A repeat c-section should not forced upon a women by an insurance company or simply because their doctor is concerned about his/her own liability insurance!! My youngest is now 12 and she was VBAC after 2 c-sections (both medically necessary). Based on some comments, I was quite fortunate and there were no complications (she was so ready to make her appearance, the doctor almost didn’t make it in time!). The entire experience was completely different than the birth of my boys. The main difference was the recovery time. A week after her birth I was chasing after her brothers (4 and 2 at the time). As long as it is medically safe and the woman has weighed all of her options, the choice should be hers!

Chumbucket

July 26th, 2010
1:30 pm

My first baby (born in 2002), was born by c-section after an entire day of labor and 6 of the most miserable, painful and frightening hours of my life attempting to push him out. My difficult labor came as a surprise to no one except my doctor. I am relatively small person who was pregnant with an obviously large baby. Nearly every doctor at the overly large OB/GYN practice I was using had warned me to be prepared for a possible c-section, yet the doctor (from the same practice) who happened to be on call when I went into labor seemed to determined to beat the odds at any cost. By the time this so-called doctor finally decided to bless me with that c-section, I had a nearly 10 lb baby stuck between my pelvic bones, every ounce of my epidural had long worn off and I was in such agony I can say, without absolute honesty, I was ready to die. I don’t know where these doctors willing to do “elective” c-sections are but I sure wish I’d had one then. After all was said and done I had a healthy baby boy to show for all my trouble, for which I am extremely grateful, but, although I recovered physically after just a few weeks, it took me 3 years to recover emotionally from the experience. As a young, healthy person I had never truly experienced pain before and I was completely traumatized by it. To this day, I have an almost neurotic fear of pain, which I will be the first to admit, has turned me into a crybaby.

As I said, It took me 3 years before I could even bear the idea of having another child, but since then I have not only had one baby, I’ve had two, both born by totally drama-free scheduled c-sections performed by, obviously, a different OB/GYN group. The whole point of me sharing my story is this: there are very compelling reasons for why doctors and mothers have c-sections. This is far too complex of an issue for any one person or group to make an across the board on.

I would always have a C Section

July 26th, 2010
1:44 pm

Yes, it does take a little longer to get over, but its not that big of a deal. And there are advantages too. Why go through all the pain of labor? Just cut it out, give me some pain killers, and keep my nether regions in tact.

HB

July 26th, 2010
1:50 pm

I see what you’re saying, Michelle, but she still had the option of finding another provider in network — a hassle, yes, and possibly an additional office fee, but not the government’s responsibility. And I do think that insurance companies that cover immunizations should reimburse their clients if they go to the health department instead of a private provider, but again, that’s an issue with the company — if they refuse, then tax dollars shouldn’t pay for the redundancy. I know how difficult it is to get everything you need, and I know what a hassle working with insurance can be, but I don’t expect the government to pay for extra/redundant services to keep me from having to jump through my company’s hoops. I don’t mind government cracking down on their practices, though, and forcing them to make it easier for clients to get the benefits they’re promised in their policies.

The standard fee of $14 is the maximum charge allowed under the federal program to cover the public or private provider costs — staff time giving the shot, paperwork, etc — involved in giving the free shot, not the cost of the shot itself. Think of it as your office copay. Your conuty’s HD may charge a larger admin fee for shots not covered by the program since those wouldn’t be held to the $14 max, but it’s my understanding that most of the larger cost is for the actual vaccine. The federal government has developed a program that pays the manufacturer (or reimburses the provider who paid the manufacturer) for the stuff in the vial for those whose insurance does not cover it because having as many people as possible vaccinated is seen as a priority in protecting everyone’s health. Your tax dollars have not paid for additional doses for the already insured. The program is funded based on the number of uninsured who need vaccines and not budgeted to cover shots for those already insured. If it were, cost of the program would go up, and you would be paying more in taxes.

meagain

July 26th, 2010
1:55 pm

I had 5 C-sections & before you go critizing let me explain. My 1st section was a vertical uterine incision so there would be NO WAY that a VBAC would have been a choice for me. Also my pelvis is too small for a baby to fit thru. I DO have a problem with women & their docs that choose to have a section because of convenience.

Thyra

July 26th, 2010
2:01 pm

I have three beautiful daughters. All by C-Section. I hated all three of them. The first one was because she was breach, the second one was an attempt at VBAC, but because of the previous C-section, I couldn’t take the drugs necessary to dilate me. The last one was because of the complications from the second C-Section (scar tissue). I hated that I had to call a nurse to get the baby out of the bassinet for the first day because I couldn’t get out of bed. I hated the bladder infections from the catheter. I hated not being able to feel my bladder to pee for 3 weeks after wards. I hated not being able to eat anything but liquids after birth until I passed gas. I hated having the painful scar (pulling the surgical tape off in the shower – yikes). That was just me. I had to watch over my daughters to make sure they didn’t choke on embryonic fluid that was still trapped in their lungs because they weren’t pushed out. I hated that they were so disoriented after birth because of the drugs I had to be on. I hated not being able to sleep comfortably for months because of the gigantic scar on my belly (that has now turned my belly into this permanent shelf under my breasts).
I would not EVER recommend a C-section to anyone unless it was absolutely necessary.

AJ

July 26th, 2010
2:05 pm

My first delivery was 16hrs natual with 4hrs pushing. My son turned sideways in the birth canal and stopped breathing. The docs did an emergency c-section and I have a healthy young boy. My second delivery, I opted for a scheduled c-section and it was the BEST choice for me and my body. I went through hell with my first (without all of the details)

kateecee

July 26th, 2010
2:14 pm

ACOG is not the American College of OBs/Gyns. It’s the American Congress of OBs/Gyns.

OP

July 26th, 2010
2:34 pm

I had a VBAC with my second child. Other thanactually going through experiencing labor for the first time it was a good experience with no complications.

Frankie

July 26th, 2010
3:28 pm

Chumbucket put it best: “This is far too complex of an issue for any one person or group to make an across the board on.”

That being said, I am in the C-Section from Hell Camp. Following an emergency C-section, I have permanent back pain from the spinal. I was unable to pick up my 9 pound baby without excruciating pain. The only answer I could get from (many) doctors regarding my back pain was that I could go to the pain clinic and get blocks. I haven’t taken up the offer for more needles in my back yet.

While I haven’t experienced a vaginal birth, I’d like to think that a few days of pain has got to be better than a few years or possibly a lifetime. Based on the fact I had a “big” baby who wasn’t yet engaged, I am not a strong canidate for a VBAC according to my doctor. At present I have decided to not have any more children because I don’t want to risk further complications.

Childbirth has never been an easy proposition. Even in modern times, we shouldn’t forget its risks.

noella

July 26th, 2010
4:48 pm

You’re supposed to suffer for your children. It’s sad and disgusting to here so many women say they chose to do a C-Section, so that it would be easier for them. It’s better for you, but not necessarily for your baby. Babies bond better with their mamas when the birth is natural; plus don’t have as many health problems. I wish American women would stop being so selfish.

Stephanie Turpin Thiess

July 26th, 2010
6:02 pm

The new guidelines do not say you HAVE to have a VBAC. They are now ALLOWING a woman to choose a VBAC (without having to stand on her head, cite articles and plead with or change docs).

My sis had a terrible time with a c-section with her first child, and when SHE choose a VBAC for her second, she had to change doctors as her doctor would NOT do a VBAC.

I am sure someone can site terrible outcomes from ANY birth choice, whether, c-section, natural, or VBAC), but that is just it, the women can live easier with it if it was THEIR choice…Choice is the issue here, not HOW, or what is best from your experience…

The new guidelines bring back CHOICE. You may choose a c-section, but shouldn’t someone else have the right to CHOOSE a VBAC, or should everyone who has EVER had a c-section be forced to have another every time they get pregnant?

Sigma6

July 26th, 2010
6:49 pm

My wife is due on 8/16. She has already scheduled her c-section for 8/9. This will be our third child. First one was vaginal. Second one was c-section. Since will be my only biological child, I want it to be a vaginal birth but wifey says that they dont give out gold medals and purple hearts for child birth! So I guess its a c-section for us! Was there for my god daughters birth (vaginal) and was amazed! I wish my wife would reconsider!