Vbac

[Bini]

Got talking about babies with some friends, and old disappointments that I thought had run their course, came back to haunt me. I try to remind myself of my husband's gentle words when I was distressed the first go around regarding my delivery process: It doesn't matter how baby is delivered, as long as you and baby are healthy. Anyone do VBAC?

[Guest]

I haven't personally, but my good friend's first birth was a c-section (twins), and she went on to have 3 uneventful vaginal births.

I've probably told you before, but my c-section was my most spiritual birthing experience. I think that there are certain groups of people who romanticize "natural", vaginal birth to the extent that other births seem inferior. They're not. Every one of my births was different and with different medical interventions, and every one of them was beautiful in its own way.

Don't rob yourself of what the birth was. It was successful. You have a beautiful little girl.

[MarginOfError]

I haven't had a VBAC myself, no.

I don't remember the conditions of your cesarean, but keep in mind that we are learning that there are fairly good indicators of whether a woman can successfully have a VBAC. Women who have a primary cesarean for non-vertex presentations, fetal distress, or urgent matters like cords wrapped around necks have about 80% success rates with VBACs.

On the other hand, women who have had c-sections due to slow progressions, failure to dilate or efface, or failure to go into labor at all have about 5 - 10% success rates with VBACs.

It is good to remember that healthy babies and healthy mothers are what matter most. We seem to have developed a culture that puts a high value on the "natural experience." But that culture tends to forget that at one point in US history, 40% of all women died during child birth; and child birth was the number one cause of death among women until almost the 1920s. It is still the number one cause of death in women in undeveloped countries. The cesarean section has probably saved more lives than any other medical procedure. So the next time that you feel like you're missing out on something because you had a c-section, remember that the first thing your probably missed out on was death.

[Guest]

2 c-sections here. Doctor strongly adviced against VBAC in my case. Matter-of-fact, we scheduled the 2nd c-section.

But yes, I do know of lots of cases of successful vbacs. I say listen to your doctor's advice.

And no, I don't feel like I "missed out" on anything except for what MOE said - certain death.

[Vort]

We seem to have developed a culture that puts a high value on the "natural experience."

Strange, then, that almost ONE-THIRD of babies born in this country are born by cutting the mother's abdomen open.

The facts are these: The C-section rate is so high in the US, NOT because C-section is safe, but BECAUSE C-SECTION IS PREDICTABLE, both in outcome and in complications. Doctors in general and surgeons in particular place high confidence in predictable, reproducible results, due in no small part to the active participation of insurers.

Why not use birthing forceps, what Bill Cosby called "salad spoons"? Because there is a cost in learning how to use them effectively. Consider Sylvester Stallone's facial paralysis, caused by forceps usage at birth. Yet when used effectively, birthing forceps have an extremely high rate of success; in the hands of a skilled user, they almost obviate the need for caesarian section, with less risk to the baby than C-section.

So why don't we put more effort into training new OBs to use forceps? Because they're old-fashioned and out of style. Because it's far easier to train a doctor to slice a woman's belly open than to teach him or her an actual skill. Because insurance companies see C-section as a more risk-averse procedure, since it's a known quantity.

The upshot? Greater pain and longer recovery for the mother. Much higher risk of infection. Problems with lactation. True, there are no more forceps delivery problems, but we have traded one set of problems -- a set amenable to improvement merely by better training of the OBs -- for another.

So does this mean that we and our descendants are doomed to have our women sliced open to have babies? No. It simply means that the US won't be leading the rest of the world in safe birthing techniques. It means that Europe, or more likely Asia or even Africa, will pioneer safe forceps deliveries, and only two or three generations later will it leak over to the US. Think "infant circumcision" and add a hundred or so years.

[Bini]

On the other hand, women who have had c-sections due to slow progressions, failure to dilate or efface, or failure to go into labor at all have about 5 - 10% success rates with VBACs.

Unfortunately, this is where I was classified. I was doing so well, I thought I was on my way to having a natural delivery, I even went to a 7 without needing any meds. Then things slowed, practically stopping shortly after at an 8, and the OB prepared me for a cesarean. Within an hour or so, I was half conscious and on the table, and my baby was delivered. I was so drugged, I really didn't care what was going on, or knew what was going on. The epi wiped me out- I wasn't strong enough to even hold my baby until the next morning to see what 9 months of pregnancy resulted in.

In my case, OB will not do VBAC.

On a positive note, the pictures taken during my cesarean were priceless. My husband was awesome and helped cut the cord - it was really hard to cut - so the doc actually ended up doing it. My husband remembers the event fondly, seeing our baby take her first breath. Wish I had been more conscious. Lol

[Vort]

But that culture tends to forget that at one point in US history, 40% of all women died during child birth

This is an untrue, misleading statistic. The 40% mortality rates were caused by puerperal fever, an infection spread by unsanitary doctors and conditions. Had they been doing C-sections in such conditions at that time, without any doubt the death rate would have been far, far higher than 40%. It is simply false to suggest that caesarian sections were responsible for lowering this 40% mortality rate.

So the next time that you feel like you're missing out on something because you had a c-section, remember that the first thing your probably missed out on was death.

I absolutely guarantee they won't miss out on death.

[Bini]

I just watched Benjamin Button and none of us miss out on death :/

[applepansy]

Vbac's are possible. But you have to be determined and you have to have a supportive doctor.

When I did my labor companion (doula) certification - years ago - I met a who were also in the class who had Vbac's. Its possible but they all recommended making sure your doctor is supportive.

(I have the names of good doctors's in SLC area who will support Vbac but I don't know what area you're in)

[MarginOfError]

Strange, then, that almost ONE-THIRD of babies born in this country are born by cutting the mother's abdomen open.

The fact that primary c-section rates* are high doesn't excuse the behavior of those that promote the ridiculous belief that anything other than a natural birth is a substandard birth.

*c-section rates beyond the primary are not used in quality indicators because it is difficult to separate the population into candidates and non-candidates for VBAC. Instead, VBAC rates are used to report quality in post-primary c-sections.

The facts are these: The C-section rate is so high in the US, NOT because C-section is safe, but BECAUSE C-SECTION IS PREDICTABLE, both in outcome and in complications. Doctors in general and surgeons in particular place high confidence in predictable, reproducible results, due in no small part to the active participation of insurers.

This is a problem in the U.S. So much so that in 2014, primary c-section rates will be a quality indicator on which Medicare will be basing reimbursements. The current benchmark for primary c-section rates is, I believe, between 15% and 19%. I can't verify that right now, however, because I don't have access to my quality reports from last year.

Another issue that has been a problem for c-section rates is the "convenience scheduling" deliveries. For the past several years, when patients have asked to be induced early so as to deliver when it suits their schedule, physicians have obliged. But once an induction is begun, it has to be seen through, often times leading to c-sections. So the problem wasn't cause entirely by the physicians (although probably about 75% of it was). I believe Medicare has plans to introduce elective delivery prior to 39 weeks as a non reimbursable procedure. Currently, at my institution, the physicians simply won't allow it any more.

Why not use birthing forceps, what Bill Cosby called "salad spoons"? Because there is a cost in learning how to use them effectively. Consider Sylvester Stallone's facial paralysis, caused by forceps usage at birth. Yet when used effectively, birthing forceps have an extremely high rate of success; in the hands of a skilled user, they almost obviate the need for caesarian section, with less risk to the baby than C-section.

Forceps and vacuum are actually discourage by OB/GYNs because they come with increased risk of infection, trauma to the child, and laceration of the perineum in the mother. The laceration is especially concerning, since it tends to heal even more poorly than the scar from a c-section.

So why don't we put more effort into training new OBs to use forceps? Because they're old-fashioned and out of style. Because it's far easier to train a doctor to slice a woman's belly open than to teach him or her an actual skill. Because insurance companies see C-section as a more risk-averse procedure, since it's a known quantity.

The upshot? Greater pain and longer recovery for the mother. Much higher risk of infection. Problems with lactation. True, there are no more forceps delivery problems, but we have traded one set of problems -- a set amenable to improvement merely by better training of the OBs -- for another.

Truth be told, if you remove instrumental vaginal deliveries, medical outcomes for c-section babies and vaginal delivery babies are very similar. But yes, the medical outcomes for the mothers are a little worse--hence the current focus in the medical community to lower primary c-section rates.

However, when you compare instrumental deliveries to c-sections, the medical outcomes tend to be worse for both children (more infections) and mothers (lacerations). Even when the instruments are put into skilled hands.

So does this mean that we and our descendants are doomed to have our women sliced open to have babies? No. It simply means that the US won't be leading the rest of the world in safe birthing techniques. It means that Europe, or more likely Asia or even Africa, will pioneer safe forceps deliveries, and only two or three generations later will it leak over to the US. Think "infant circumcision" and add a hundred or so years.

Discussion of lowering primary c-section rates has been happening for about 10 years now. One of the major issues that we've had in lowering the rates is that medical records have been insufficient for producing rapid feedback about the issue. Even at an institution as large as mine, we have to go through every single record individually to classify it. We are finally installing a new product that will allow us to do this instantaneously and provide monthly feedback on these statistics in an efficient manner. To put that into perspective, we were manually reviewing over 10,000 records every year to classify these procedures. And we represent only about half of the deliveries in the area.

So, contrary to your theory, the US is actively engaged in reducing the rate of primary c-sections. What's more, one of the hot topics of research is identifying subgroups of women that will respond well to VBAC. I believe a researcher in Florida produced a predictive model about two years ago that has been performing well.

[applepansy]

Discussion of lowering primary c-section rates has been happening for about 10 years now. One of the major issues that we've had in lowering the rates is that medical records have been insufficient for producing rapid feedback about the issue. Even at an institution as large as mine, we have to go through every single record individually to classify it. We are finally installing a new product that will allow us to do this instantaneously and provide monthly feedback on these statistics in an efficient manner. To put that into perspective, we were manually reviewing over 10,000 records every year to classify these procedures. And we represent only about half of the deliveries in the area.

So, contrary to your theory, the US is actively engaged in reducing the rate of primary c-sections. What's more, one of the hot topics of research is identifying subgroups of women that will respond well to VBAC. I believe a researcher in Florida produced a predictive model about two years ago that has been performing well.

The only thing I completely agree with in your post is the bolded.

Discussion of lowering primary C-section rates has been happening here in Utah for closer to 20 years that I personally know about and probably longer. And biggest concern 20 years ago were doctors who thought "once a C-section, always a C-section." Its taken those doctors retiring and the younger doctors being educated about the issue to see significant change.

20 years ago if a woman wanted a Vbac she usually had to have a home delivery thus increasing the risks both to herself and the baby. At least Vbacs are more common now and there are doctors who are supportive.

Vort's makes some very valid points.

However, the best outcome is a healthy mom and a healthy baby. As long as everyone involved in a pregnancy has that goal in mind things go well. When a doctor makes decisions which prolong labor and then order a C-section for convenience then they aren't putting the Healthy Mom/Healthy Baby priority first. (I was involved in a delivery where a female OB ordered a epidural and dosage level that was outrages and did so without much interference because the parents spoke little English. Mom couldn't move around. We could see the baby twisting and twisting to get into position. It could have been avoided but the doctor was "busy") There are so many of these stories (yes I know anecdotal) that finally the medical community said "maybe we need to listen better."

[annewandering]

When I had my first baby 40 years ago people were talking about reducing the numbers of C-Sections. It is not a new subject, certainly not just 10 or 20 years old.

Problem is it was the women who were discussing it with very few doctors. There was a climate of extreme distrust on both sides. I personally bore the brunt, or should I say very sharp jabbing fingers, because of disagreements with my ob.

Many of us decided it was not worth the dangers in a hospital birth and opted for prenatal care and home births. It has taken 40 years for doctors to finally listen to us even if it is in a very odd way. We knew then that women could have natural births even with a previous c-section.

I am sensing an almost angry feeling to those who adamantly prefer natural. That is very sad. It is because of women demanding better care and natural births that so much has changed in 40 years. Not enough but a lot.

[Bini]

Apple, I am in north downtown SLC, Avenues area. I am very interested in knowing all my options for my next pregnancy. I would love to do a VBAC if it is in the cards for me. I'm not going to submit myself into any one situation that potentially raises safety risks. As much as I would love to have a vaginal delivery, a safe and healthy outcome is foremost important.

[Guest]

I am sensing an almost angry feeling to those who adamantly prefer natural. That is very sad.

Anne, are you talking about posts in this thread or just in general? We're not angry over those who adamantly prefer natural. What we have a problem over is those who adamantly insist that women who go through a c-section instead of a vbac are somehow "less of a mother" or "missing out" or some such.

This is what I thought Bini was feeling - that she missed out somehow because she had a c-section, so she is desperate for a vbac to not miss out anymore...

It is because of women demanding better care and natural births that so much has changed in 40 years. Not enough but a lot.

It's interesting that in the rural areas of the Philippines, a third world country, giving birth is considered a natural process, not a medical process. It's something akin to pooping! It only becomes a medical process when medical complications occur. It is a common joke there that a Filipino woman would be carrying her basket of fish to the market, go into labor, go to the side of the road, push the baby out, put the baby in the basket with the fish, and continue on to the market...

Edited August 17, 2012 by anatess

[annewandering]

I was talking about this thread. No woman should feel like less of a mom because of necessity and I would hope that is clear. Bini did miss out on something but that is just life. Baby and safety is more important than what we would like or prefer. I am just glad that more women see they have choices in most cases.

When there is no intelligent choice other than c-section, well then that is what they are for. A healthy mom and baby is an excellent outcome however it came about. :)

Bini, I understand why you would want the vbac. I would give up every one of my natural births if it was the difference between a good outcome and not so good. If you knew me you would know I have serious issues with UNNECESSARY interventions but unnecessary is the key word. Keep in mind that an excellent mom is going to put the safety of the baby first, as I know you do.

[Guest]

I was talking about this thread. No woman should feel like less of a mom because of necessity and I would hope that is clear. Bini did miss out on something but that is just life. Baby and safety is more important than what we would like or prefer. I am just glad that more women see they have choices in most cases.

When there is no intelligent choice other than c-section, well then that is what they are for. A healthy mom and baby is an excellent outcome however it came about. :)

Bini, I understand why you would want the vbac. I would give up every one of my natural births if it was the difference between a good outcome and not so good. If you knew me you would know I have serious issues with UNNECESSARY interventions but unnecessary is the key word. Keep in mind that an excellent mom is going to put the safety of the baby first, as I know you do.

Okay, what exactly did Bini miss?

[Bini]

I'd like to make a simple request and keep this thread away from the debate of natural birth is superior to cesarean.

Bini did miss out on something but that is just life.

Wasn't expecting that.

While a cesarean wasn't my first choice, and I was certainly under the influence of the epi, I had a vast range of emotions going through my body at the time. The feeling of finally having the baby arrive was overwhelming, despite being physically and mentally drained. While I was certainly under the influence of the epi, I was awake on the operating table, looking up at my husband by my side and holding his hand tightly. I remember the strange feelings of pressure and being poked around at. But the highlighting moment, was when I saw my beautiful baby for the first time raised up over the curtain edge, and rested upon my chest, where I got to hold her before she was cleaned up. I had planned on crying but so much was going on, it never happened.

My core tells me that, unless something is wrong, a birth is a birth - and quite a wonderful process and miracle at that. Doesn't matter if the baby arrived through the birth canal and out of one's vagina, or is delivered via cesarean. However, my disappointment comes from being involved in a SLC au naturale birth club that has a superiority complex when it comes to remaining natural, and avoiding medical interventions. When things didn't pan out the way I wanted them to during my delivery process, that burden of "Look at me, I'm an au natural mama", came crashing down on me. It added a lot of unnecessary and additional stress to my PPD. I'm so blessed to have a husband that lets me know, and reminds me, that I didn't miss out on anything! The unfortunate thing about all this, is that for NEW mothers, people don't realise the implications of ANY one bias can cause. I regretfully allow myself to fall into that rut of feeling defeated when I have nothing to feel defeated about. It would be like me telling an adoptive mother that she missed out on having her own children - she didn't! She IS a mother, didn't miss out on motherhood, just didn't come about baby the same way that my husband and I did.

[pam]

Bini I'm with you. You didn't miss out on anything. A baby being born is truly a miracle and a wonderful experience. Whether C-section or vaginally it doesn't matter. The fact is you brought this wonderful, precious little girl into the world to be a part of your family. THAT is the thing to focus on.

[Wingnut]

Bini, you are wise beyond your years. :) I'm glad to see you so grounded about it.

When my first was born via an unscheduled c-section (though not traumatic or overly chaotic), people kept asking me about the birth stats afterward, and I would say, "she was 5 lbs., 4 oz, 17 3/4 inches long, and she was born at...well, they pulled her out at...12:08pm." I had a hard time saying that she was "born" at such-and-such a time, because it all felt so clinical -- she wasn't born, she was extracted. After a few days I got over it, and with my second (a schedule c-section), I didn't have the disconnect. I had never had my heart set on natural or anything -- I didn't really have a birth plan at all, as a matter of fact. But it did feel (at first) like I'd missed something. I got over it quickly.

[Guest]

However, my disappointment comes from being involved in a SLC au naturale birth club that has a superiority complex when it comes to remaining natural, and avoiding medical interventions. When things didn't pan out the way I wanted them to during my delivery process, that burden of "Look at me, I'm an au natural mama", came crashing down on me.

Bini, there's some line I got out of a song:

Don't read beauty magazines. It only makes you feel ugly.

* disclaimer. I read beauty magazines on occasion. I just don't give it the power to make me feel ugly...

[applepansy]

Apple, I am in north downtown SLC, Avenues area. I am very interested in knowing all my options for my next pregnancy. I would love to do a VBAC if it is in the cards for me. I'm not going to submit myself into any one situation that potentially raises safety risks. As much as I would love to have a vaginal delivery, a safe and healthy outcome is foremost important.

Avenues Women's Center

My sisters both see Dr. Macy. My almost Daughter-in-law is going to Dr. Macy too. The other doctors there are wonderful and will support a Vbac.

BTW, LDS Hospital is the BEST place to have a baby in the Western USA. Amazing rating.

Addition: Anatess and Bini, I need some advice. I'll send a PM. My almost daughter-in-law is Filipino.

Edited August 17, 2012 by applepansy

[bluedreams]

On the other hand, women who have had c-sections due to slow progressions, failure to dilate or efface, or failure to go into labor at all have about 5 - 10% success rates with VBACs.

Do you have a reference for that? I'm extremely curious about birth and love learning about it...i've never seen this stat and would like to see.

Bini,

My mother had 5 VBAC's after an emergency c-section for her 2nd child (his heart rate flat lined....it was extremely emergency). She never had a problem with them. Her hardest problem was with her doctor with the last one. They were really pushing for a c-section. So hard that they told this woman who's pushed out 5 other children that they were worried that the last baby's stomach (not head, stomach) would be able to pass through her pelvis. They were probably mostly skittish by her age than anything else, to be honest (she was almost 45). There wasn't a problem though, the baby came out so fast that she didn't have time for an epi (mom was NOT happy about that. I joked it was God's way of telling her she was done with having children). She's by no means in the natural birth camp of things...but I think her experience with the c-section strongly made her determined to have vaginal deliveries after (for example, she can't hold her bladder for very long since then).

With luv,

BD

Edited September 7, 2012 by bluedreams

[bluedreams]

One last thing, I was randomly looking at this website (Induction, C-Section, & VBAC Facts - Improving Birth) when I noticed this post. There's also a link to this website all about VBAC's here: International Cesarean Awareness Network.

Personally I've had my friends/family all range with birth. Births come wtih their definite hiccups and plans change. One friend was exploring at-home birth until she became high risk in the 2nd trimester...she still had a natural, medicated birth...but her plans for it definitely changed. Another friend had her dream waterbirth at home. Another friend chose/desired medication for both births, though had to be induced with a second (not her 1st choice at all...the induction, medication was a definite yes). Me? I'd like to have natural births and are leaning to homebirths/birthing centers. But life is full of uncertainties. So I'd say study up as much as possible and then be ok if plan A and even B don't work out.

With luv,

BD

[MarginOfError]

Do you have a reference for that? I'm extremely curious about birth and love learning about it...i've never seen this stat and would like to see.

Bini,

My mother had 5 VBAC's after an emergency c-section for her 2nd child (his heart rate flat lined....it was extremely emergency). She never had a problem with them. Her hardest problem was with her doctor with the last one. They were really pushing for a c-section. So hard that they told this woman who's pushed out 5 other children that they were worried that the last baby's stomach (not head, stomach) would be able to pass through her pelvis. They were probably mostly skittish by her age than anything else, to be honest (she was almost 45). There wasn't a problem though, the baby came out so fast that she didn't have time for an epi (mom was NOT happy about that. I joked it was God's way of telling her she was done with having children). She's by no means in the natural birth camp of things...but I think her experience with the c-section strongly made her determined to have vaginal deliveries after (for example, she can't hold her bladder for very long since then).

With luv,

BD

I don't have one immediately available. These are numbers that have been discussed in some of my meetings with physicians.

[Bini]

I have no hang-ups with having my delivery at the hospital. The hospital and OB are still capable of honouring your Birth Plan, whatever it be. I had two friends that went au naturale but only one of them actually had her babies (she had two) at home. She said it happened this way primarily because she did not have insurance, and a midwife was an affordable route to go.

Anyway, as I rethink this, I classify a "natural" birth only one that resulted in no medical intervention. So a vaginal delivery with meds is not a natural birth, nor is a cesarean. They are what they are, a vaginal delivery, and a cesarean.