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Pregnancy & Birth :
Vaginal Birth After Cesarean (VBAC)

I have literally spent HOURS and HOURS pouring over websites, magazines, books, and egroups, reading all I can get my hands on about VBAC (pronounced "vee-back"). Now granted, I am no expert, and I am NOT a medical professional...so take my views as you will, but NOT as expert opinion...I am an educated woman who does her research on issues that relate to me and my situation...as we all should. So please do your own research and learn things for your own situation. This is just what I've learned and wanted to share.

What I've learned has made me stronger than ever in my desire to have a vaginal birth from here on out: VBAC is statistically safer, all risks taken into consideration, than a repeat c-section (which is MAJOR abdominal surgery!!), for both mom and baby. But this is not the information that pregnant women receive. What's infuriating is that despite evidence that supports how safe VBACs are (barring no complications), women who want to have a VBAC have to fight like hell to get one! Part of the reason is that a VERY FLAWED study came out a couple years ago that the doctors and insurance companies have decided says that a repeat c-section is safer than a VBAC....But here's a discussion on that research, called "Is vaginal birth after cesarean risky?" that suggest otherwise.

Here's a very interesting quote from the above article that points out some of the problems with the conclusions that are being made of this flawed study:

"In point of fact, this study had nothing to say about the merits of planned cesarean versus VBAC because it only considered uterine rupture. And while VBAC women have a slightly greater risk of this, cesarean section introduces a host of other complications that occur much less often with vaginal birth."

What is it that doctors usually say they are concerned about with VBACs? Uterine rupture. Let me tell you what I've learned about uterine rupture in all my research. If you are attempting a VBAC with a horizontal incision (vs vertical...and as far as I know, pretty much no one does vertical incisions anymore...and haven't for some time...although there may be some docs totally out of it out there...) down low (the standard c-section these days is the "bikini cut" because these are the most safe, since that's the strongest part of the uterus and heals best)...your chance of uterine rupture is about 1%...That's less than 1 in 100. Maybe still a little scary, but lets put this in perspective...the risk of uterine rupture for a first time birth that is induced with pitocin is statistically HIGHER than 1%! (I haven't been able to find a number for this anywhere, just references to it being higher.) So, its riskier to induce a first time mom, due to the risk of uterine rupture, but they do it all the time...and yet, its not an "acceptable risk" to allow a woman to have a VBAC???? Something that is statistically LESS risky???

Here's something interesting about that 1% number...according to a local OB whom I trust, that 1% is also inaccurate. According to this doctor, it all depends on what they are classifying as a "rupture"...and they will often classify a "window" as a rupture...a window is a scar that has stretched so thin you can almost see through it (hence the term "window"), but has not broken. And many times these and minor tiny ruptures that never caused any complications are discovered when the mother has a c-section for a totally different reason and they just notice that its there when they open her up for this other reason...it never was a medical emergency itself. This doctor tells me he thinks the chance of a "catastrophic" uterine rupture, where the baby ends up outside the uterus, is more like 1 in a THOUSAND or even 1 in TWO THOUSAND. Its pretty rare. Most doctors have never seen one.

And another interesting thing to note...if you ask a doctor that has seen a catastrophic uterine rupture for more details of the emergency, you will find out some interesting things...every single one I've personally read about or heard about had pitocin and/or an epidural involved. Once you involve drugs in the equation, its no wonder that scary things happen! With pitocin you have unnaturally strong contractions forced on a cesarian scar, which is KNOWN in the medical community to GREATLY INCREASE your risk of rupture (yet they do it anyway, usually without telling the mom of the risks.) And with epidural, you can't feel one of the telltale signs of rupture...sharp abdominal pain. So you don't KNOW that something's wrong, and neither do they. All this info just seems like such a "DUH!!!" to me...So if you go totally natural, with no interventions, your chance of a true emergency from uterine rupture is so very small...and in all I've read, the interventions that are standard procedure at hospitals these days are FAR RISKIER!!

Check out these articles for some very enlightening information:

VBAC Safety: A Closer Look at the 2002 JAMA Study
What Every Midwife Should Know About ACOG and VBAC: Critique of ACOG Practice
Vaginal Birth After Cesarean and Uterine Rupture Rates in California for 1995 (make sure to check out the stats at the bottom of this one)

It is also important to know that uterine rupture is not always fatal. They make it sound like your uterus explodes or something...but in actuality, from the midwives I've talked to locally who have decades of experience and knowledge, and all the info I've read...most uterine ruptures are NOT fatal, to mom or baby, if detected and acted upon appropriately. They can simply mean a tiny tear in the uterus and sometimes moms can still go on to deliver vaginally with this...although c-sections are most often done for ruptures...But moms and babies are not automatically going to die if you have a rupture! And being in the hospital does not guarantee that rupture will be noticed...check out this link for some sad rupture stories.

Fresno is so far behind the research when it comes to birth...many local midwives refer to Fresno as being in the "dark ages" regarding birth in general...VBAC particularly! You could go to Visalia or Selma and find a more enlightened medical community! Why is this? Why do we have to go to smaller, presumably less-advanced towns (big presumption there...just going on the thought that the bigger cities should have better resources overall...not so with Fresno), to find a more educated community in regards to birth? This is so utterly ridiculous it enrages me whenever I think about it! Birth is supposed to be a beautiful experience, not a fight!

So what can we, as Fresnans, do about all this? Demand better from our care providers. And in order to do this, you have to EDUCATE YOURSELF.

There was a recent article in Mothering Magazine (Nov/Dec 2003...pg. 6) by Peggy O'Mara, publisher and editor of the magazine, that details the current alarming trend in America towards c-sections...we've reached an all-time high of over 26%! To put this in perspective, that's more than 1 in 4 women! The World Health Organization says that an acceptable c-section rate would be between 10 and 15%. Ms. O'Mara says this about the current sad facts in our country regarding c-section:

"Reluctantly, I blame the mothers. I blame women when we don't expect more of ourselves. I blame women when we believe we have a limited capacity. I blame women for being immobilized by cultural myths about birth..."

I have to say, also reluctantly, that I agree with her. If we, mothers, as a whole, educated ourselves better on birth...we'd be less inclined to blindly believe what our doctors tell us...we'd know that many of the interventions that are routine are not only not usually necessary, but can actually be damaging...and frequently lead to the downward spiral of interventions that so often ends in c-section. And going by statistical facts, so many c-sections are not actually necessary...so many are a result of all those interventions, and the general attitude in the medical community of birth being an illness, not a natural event. So if we, as mothers, trusted our bodies and knew our facts about normal birth...we wouldn't stand for all the unnecessary procedures that can set us up for c-sections! If we were more educated as a whole...we would demand that our babies be born they way nature intended, the way our bodies were designed...But instead, those of us who do this are a minority in American society, and often viewed as weirdos! Because we want to do what our bodies were intended to do!! Imagine that!! What are we, nuts?

Now, I am not of the mindset that doctors are evil conspirators out to get us. But I do believe that they do not always have or give out correct information...knowingly or unknowingly, its still a common thing to get advice from doctors that is NOT based on scientific research. They just recently had a show on Oprah called "Outrageous Medical Mistakes" in which Dr. Sanjay Gupta said that a lot of the advice doctors dole out is anecdotal...not based on research, but based on their own experiences, or what they've heard from other doctors. This is not representative of births overall, but just on the tiny percentage they deal with (in the scheme of things...looking at the big picture here). He also said that the doctors that are more recently out of medical school will often be better educated on current research, as the more experienced doctors don't always keep up with the current research...and many don't even know that they don't have correct info!

I've lost count of how many stories I've heard that showed how true this is...particularly in regards to birth. So many stories of false info given to patients by doctors...many with very sad results. And if you haven't educated yourself, you don't know that what they are telling you is false. Very annoying that the patients have to keep the doctors in line...after all, they are the ones that went to medical school! But the fact of the matter is that they don't always know what they are talking about, unfortunately. And you won't know this if you don't do your own research.

Another important thing to note is that doctors decide for themselves what is and isn't a worthwhile risk...and this is based hugely on their malpractice insurance. And I can't really fault them on this...they are looking at the big picture for themselves, and if people in our culture weren't so quick to sue if things don't turn out exactly the way they envisioned it, we might have a very different medical community. Unfortunately, malpractice suits happen all the time, and because of this, the insurance companies that sell the malpractice insurance have a lot of control over what is and isn't an "acceptable risk"...this trickles down to the doctor, which in turn trickles down to us. For example... When I was in search of a local doctor that would give me the chance to do a VBAC...I heard time and time again "No, we don't do VBACs, our malpractice insurance won't cover the risk." And I even was told by some of those doctors/midwives that they agree with me, that they know the research and know that VBAC is safe, but their hands are tied. So basically, the insurance companies, who are not medical professionals, have decided that VBACs are not worth the risk, and yet c-sections, which are not only a significantly higher risk to both mothers and babies, but also MUCH MORE EXPENSIVE for insurance companies, are worth the risk? Who decides which risks are acceptable and which are not? The insurance companies and doctors, not us. And who's body is it? And who's child is it? These judgements are made by people other than us, the parents and the recipiant of the risks, all the time...Its all so backward and twisted, it makes me angry to think about it.

So, my point with all this? Don't let anyone tell you that VBAC is unsafe! Do your research and find out for yourself what is true and what's not...YOU decide for YOU AND YOUR BABY what is and isn't an "acceptable risk"!! Don't let insurance companies and doctors make the decisions for you! And demand the kind of birth that both you and your baby deserve! C-sections are NOT "safe", despite how many are done...and vaginal birth is, barring any actual emergency, always safer.

Of course I'm not suggesting that ALL c-sections are unnecessary...there are times when c-sections DO save babies and mommies...and thank heavens for medical progress in those cases! But the numbers do not support that all c-sections that are performed these days are necessary. It is not possible that in only a matter of a few generations that human mother's bodies have forgotten how to give birth.

Trust you body, trust your baby, trust yourself...and DO YOUR RESEARCH!!!

Check out the book recommendations in the left column (click on the book covers to view their info on amazon.)

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