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When my sister in law told me that her hospital in rural Vermont didn't perform VBACS, I was surprised. After all, they seemed to have a progressive birthing unit with midwives and nurses that support and encourage natural birth. Essentially, they eliminated that option for my sister in law. She's have to drive an hour north or south to deliver her baby in a hospital that supported VBACs. Not an easy thing to do in the typically snow heavy early spring when she was due.
So then I pick up Time magazine, and see this article, entitled, The Trouble with Repeat Cesareans. I guess my sister in law is not alone. Time cited a study where 49% of hospitals either don't allow VBACs, or don't have anyone willing to perform them. Almost half. The choices of moms in rural areas are completely limited by this fact.
The article goes on to explain what made hospital so gun shy. "In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines."
This sort of staffing is difficult in rural hospitals. And it also has to do with insurance. According to one doctor from the article, "You don't get sued for doing a C section. You get sued for not doing one."
The risk of a VBAC is significant, but small, with the risk of uterine rupture at .7 percent of cases, according to the article. But the real eye opener for me was the risk of second C-sections. I gulped when I read this, as my sister in law was about to go in for her second C-section.
"Of course, the alternative to a VBAC isn't risk-free either. With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop."
Many hospitals are limiting a mother's choice of how to try and birth her baby. Maybe we should look at the data, and the mother's choice before the staffing and insurance challenges at hospitals. My sister in law delivered a healthy, beautiful baby girl via C-section just a few days ago, and I breathed a deep sigh of relief.
What about you, readers? Did you have an opportunity to have a VBAC? Were your choices limited? Did you have a repeat C-section because you wanted to, or because you had no other choice?
Monday, March 30, 2009
Non-Toxic Kids Pregnancy Series: Hospitals Limit Choices for Moms Hoping for VBAC (Vaginal Birth After Cesarean)
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5 comments:
I had a vbac many years ago. We eat organic and use medical intervention sparingly. That said, I regret the vbac. My child had some cervical injuries and I needed to have some surgical procedures to undo some of the damage. Most GYNs can still tell when I have an exam that I had the vbac. A vbac should be chosen very carefully.
Thank you for this post. I've had 2 vaginal births and 1 c-section (my first twin was vaginal and the second was an emergency c-section). We're debating having a 4th so I asked my OB about a VBAC. Based on stories like this, I was expecting a fight. But she was very encouraging and positive about and said since I delivered vaginally twice without any complications, a VBAC was very possible for me.
Thanks for your comments! I am sorry about the experience of the first commenter. I am merely suggesting that the choice be the woman's. I haven't had a c-section or VBAC, so I don't know these issues personally as you do. Thanks for commenting.
Marianna,
That is great news! I think this mostly applies to rural areas.
Thanks for commenting!
I'm glad I read this post after I had my 2nd c-section last week! We live in a mid-size city, and my doctor was very open to the idea of a vbac - from the beginning of my pregnancy she said the baby typically decides what the options are. My baby was breeched so c-section it was.
I wanted a VBAC, but ended up with a C-section due to my baby being breech. But my OB had been quite optimistic about my chances of delivering vaginally had my daughter not been breech. I had delivered vaginally on my first pregnancy, which she said greatly improves the odds of a successful VBAC.
The hospital nearest me didn't offer the option of VBAC, or at least not in a way that my OB was willing to deal with, but one a half hour away (very close to my mother's house) would have let us do the VBAC, so up until my baby turned out to be breech, that had been the plan.
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