Thread: Vbac

http://www.aolhealth.com/2010/03/11/...e-necessary%2F

Panel: Repeat C-Sections May Not Be Necessary

Too many pregnant women who want to avoid a repeat cesarean delivery are being denied the chance, concludes a government panel that urged doctors to rethink litigation-spurred policies that have swung the pendulum back toward the days of "once a C-section, always a C-section."

Fifteen years ago, nearly 3 in 10 women who had a first C-section were able to deliver their next baby vaginally, a trend called VBAC for "vaginal birth after cesarean."

Now that rate has dropped to 1 in 10, in part because a third of hospitals and half of physicians ban women from attempting VBAC, a panel of specialists convened by the National Institutes of Health said Wednesday.

But VBAC remains a safe alternative for the right candidates, and when those women try labor, between 60 percent and 80 percent of the time they do give birth vaginally, the NIH panel concluded. It urged that doctors offer mothers-to-be an unbiased look at the pros and cons, so they can decide for themselves.

"We believe that many women should have an opportunity to give it a try," said panelist and Delaware obstetrician Dr. Nancy Frances Petit of the U.S. Uniformed Health Services.

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 like placenta abnormalities or hemorrhage.

Decades ago, doctors almost always recommended a repeat C-section, worried that the rigors of labor could cause a uterus scarred from the first surgery to rupture. But in 1980, government experts concluded that many mothers could safely deliver vaginally the next time, citing evidence that their risk of a uterine rupture was less than 1 percent.

Yet the last decade saw the pendulum swing back again: Among 19 states that track VBAC, 92 percent of women had a repeat cesarean for their next delivery in 2006. And in 1999, the American College of Obstetricians and Gynecologists issued guidelines saying VBAC should be attempted only in hospitals equipped for immediate emergency surgery - and many smaller and rural hospitals aren't.

What sparked the latest shift? It's partly concern over litigation, the NIH panel said, because while a uterine rupture remains very rare, it can be devastating to the family and end in a high-dollar lawsuit.

Case-by-case decisions are crucial, the panel said, because there may be instances where another C-section is better for the baby but not for mom or vice versa.

Who's a good candidate? The panel said that needs further study. But in general, VBAC is for women who've had one prior C-section done with a "transverse" scar, the most common kind today, said panel chairman Dr. F. Gary Cunningham of the University of Texas Southwestern Medical Center at Dallas. Women should be otherwise low-risk, he said: Not carrying multiples or a large baby, being obese or having high blood pressure or diabetes.

"There's still a lot we don't know about which women will be successful in having a VBAC, but we believe it's essential that women's desires and preferences be respected throughout the decision-making process," Cunningham said.

Don't try to pre-judge candidates, said Dr. Emily Spencer Lukacz of the University of California, San Diego.

"All women who have prior cesarean delivery should talk to their providers about VBAC," so they can decide on a case-by-case basis if it makes sense, Lukacz said.

It can be difficult for women to find a doctor or hospital that offers VBAC, said Debra Bingham of Lamaze International. She points to California, which now lists VBAC availability for every hospital on a Web site: http://www.calhospitalcompare.org.




well, I have 3 children, the first I had to have a c-section because she turned breach at the last minute, the second because she wouldn't go under the pelvic bone, but with my second one the doctor did allow me to go through labor etc... and try for a VBAC, with my third one I got a doctor who absolutely said no, once a c-section, always a c-section.... I would have loved for one last chance to have tried for a VBAC.

I had an emergency c-section with my second child and a VBAC with my third. I would take the VBAC over a c-section any day since the recovery time is so much shorter!

http://www.parentdish.com/2010/03/15...of-a-mother%2F

Opinion: I Had a C-Section - Does That Make Me Less of a Mother?
by Amy Hatch (Subscribe to Amy Hatch's posts) Mar 15th 2010 4:00PM




The National Institutes of Health got a bunch of medical bigwigs together last week to talk about cesarean delivery and what they called the "troubling fact" that women who want to try for a vaginal birth after a C-section (VBAC) are often denied that option.

The panel supports the idea of allowing a woman to pursue a VBAC, and the research seems to bear out the fact that, for many, a vaginal birth after a surgical one is a viable option: According to the NIH press release about the panel, labor is successful in nearly 75 percent of VBAC cases.

"About 70 percent of women who have had Cesareans are good candidates for trying for a normal birth, and 60 percent to 80 percent of those who try succeed," Dr. F. Gary Cunningham, the conference chairman and a professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas, tells The Money Times.

What's troubling to me is not the fact that Cunningham wants more women to have access to VBACs. No, what's troubling to me is how he called the way I birthed my children abnormal. I had two C-sections -- the first one because my daughter was breech, and the second an elective repeat C-section. The assertion that my birth experiences were less than normal is totally insulting.

I had surgery. I had an epidural. I had stitches and pain medication for weeks afterward. Does that make my birth experience unnatural? Does it make me less of a woman or a mother? What do people get out of vaginal birth that I didn't experience? I had a baby, I saw her face and nearly broke from the love of it.

But if you listen to other mothers, and some fathers, too, what happened to me was not a joyful emotional experience. What happened to me, some would say, was akin to rape.

Yes, you heard that right. Rape. A post about C-sections by writer Julie Marsh (she had three C-sections) on her blog, "The Mom Slant," drew comments so inflammatory that she eventually closed them down. Marsh writes about a Twitter debate sparked by a joke about post-baby sex, in which some compared a C-section to torture and yes, rape -- the idea being that a woman suffers a loss of control over what happens to her body when a doctor proposes a surgical birth.

"As far as the 'rape' issue, it holds water. The rape is not necessarily the c-section. It is the lies told by the physician. It is the physician imposing his 'knowledge' to intimidate women into doing something they don't want. We're not talking about life saving situations," writes one commenter.

What strikes me, beyond the complete disregard for the victims of actual rape, is how viciously women will attack one another for making a deeply personal decision about the birth of their children. It's another flag of superiority to wave around: I had a vaginal birth, hear me roar! Oh, you poor dear, they must have steamrolled you into that abhorrent C-section! Even better are the moms who choose to have a drug-free birth and then run around proclaiming that no other method of delivery should be considered.

It's just one more way to divide us -- C-sections, breastfeeding, attachment-parenting -- oh, so many ways to judge! So many ways to disagree! So many ways to assert moral superiority!

I'm sympathetic to anyone whose birth was marred by any kind of trauma, mental or physical. I know there are women out there who do suffer tremendously during their C-sections. I also know there are women out there who suffer tremendously during their vaginal births. Let's face it -- birthing babies is no picnic, no matter how they make their entrance.

Do I think women who want to attempt a VBAC should be allowed to do so, if the circumstances dictate that it's safe for both Mom and baby? I sure do. Hey, it's even A-OK with me if you want to pop a squat in the forest and have your kid while someone braids your hair and sings "Kumbaya." Bottom line: How you give birth is your decision and how you arrive at that decision is no one's business.

Women -- all human beings, in fact -- have the right to make decisions about their own bodies.

What we don't have the right to do is cast aspersions on how other people's children enter this world. This is a fundamentally personal moment in the life of a mother and no one -- not even Dr. Cunningham -- has the right to tell me that what I experienced was wrong.