XP: Time Magazine talks about VBAC vs. Repeat Cesarean
Mrs.tlcS
member
A pretty good article about the state of maternity care (with regards to C-section/repeat C-section/VBAC). This
is a topic near and dear to my heart - I ended up with a disaster of a
birth, ending in C-section, with DD - and hope to give birth vaginally
to my next child.
https://www.time.com/time/magazine/article/0,9171,1880665-1,00.html
Some highlights:
Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that "once a cesarean, always a cesarean"--an axiom thought to be outmoded in the 1990s--is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them.
After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean. (bolding mine)
Some doctors...argue that any facility ill equipped for VBACs shouldn't do labor and delivery at all. "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study.
According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one. (bolding mine)
Re: XP: Time Magazine talks about VBAC vs. Repeat Cesarean
They didn't leave it out
You have to click the link
I only pulled out exerpts I wanted to highlight
Thanks for the post! I def want to read the article. I had an amazing VBAC with DD and it makes me so sad to hear women are actually denied the opportunity to VBAC.
I really liked my OB and he explained pretty well why most VBACs are ill-advised and he won't do them. I don't understand why you'd increase your risk of death even slightly by trying a VBAC. I had a vag birth, trust me you are not missing anything. I've had 32 abdominal major MAJOR (ie put c sections in the shade) surgeries, and they were a walk i nthe park in comparison.
?If you want a VBAC more power to you, but I don't think you can blame any Dr for not wanting to share your risk.
Also WTF does it matter if 100% of births are c sections if the mothers and babies all survive and are healthy? Which they almost certainly would be in the first world.
The damage to c section's press is all in the emergency ones. PEople are so hyped on avoiding them they fight them until they're emergencies then complain they had to go through labour then surgery. ?I couldn't care less if I had a c section, just give me nice nursing staff and a healthy baby.?
Um... really? ALL surgeries have risks. Including c-sections. The death rate is higher for c-sections than it is for vaginal births. You don't know why we would "increase [our] risk of death even slightly by trying a VBAC"- why would you increase yours by signing up for unneccessary surgery? People die on surgical tables all the time. Despite what you think, 100% of surgical births do not result in happy and healthy mothers and babies, even in the first world. The maternal death rate is currently rising in the US, and many suspect that it is due to increased c-sections.
A vaginal birth is safer than a surgical birth in a normal, low risk pregnancy. Having a previous c-section does not automatically put you in the high-risk category.
"Cesarean is also considered major surgery and, as such, is not without risks to mother and child, such as hemorrhage, infection and venous thromboembolism, and may place future pregnancies at increased risk for placenta previa, placenta accreta, uterine rupture, and peripartum hysterectomy. In addition, the process of labor and delivery helps prepare your baby for life outside the womb by helping him or her to expel much of the mucus and fluid from his lungs. There is also a decreased incidence of surgery-related fetal injuries (lacerations, broken bones) with a VBAC.
A study released in the New England Journal of Medicine in December, 2004 followed nearly 34,000 women who were giving birth to their second child at 19 academic hospitals between 2000 and 2003. Approximately 18,000 of those women chose a VBAC, while 16,000 elected to have a second c-section. Of the women who attempted a VBAC, 74 percent of them succeeded in a vaginal birth, and 16 percent ended up having c-sections. Uterine rupture occurred in 0.7 percent of the VBAC women, seven babies (0.04 percent of all the planned VBAC) suffered hypoxia-related brain damage that was most likely caused by the uterine rupture, and two of those babies died (0.01 percent). However, twice as many women died during their second c-section as those who had a VBAC (7 and 3, respectively)."
Well, how nice for you that you like your OB; however, your OB is not practicing based on evidence if he is telling you that VBACs are ill-advised. The current research shows that VBACs are not ill-advised. Really, there's no reason that one in three babies in the US has to be delivered surgically. Arbitrary timetables and unnecessary interventions that hospitals have been using are actually causing poorer birth outcomes (this has been shown repeatedly in the literature).
There are also risks associated with repeat cesarean section. As a matter of fact, they include uterine rupture (equal risk to primary vaginal birth - or about 0.2%), injury to internal organs, infection (50x more common in surgical delivery vs. vaginal delivery), pulmonary embolism, later reproductive problems (including miscarriage, ectopic pregnancy and infertility), premature delivery, placenta accreta, placenta previa, and maternal death. These risks are glossed over if they are ever discussed at all (and by discussed, I mean discussed. When a patient has concerns about anything on the informed consent form, it shouldn't be dismissed out of hand.
Well, actually, they're not all surviving. And they're certainly not all healthy. The reason elective sections get so much negative attention is because the outcomes are not good. Babies are being born prematurely, with problems associated with prematurity. Despite the increasing availability of interventions, more babies are being born sick, more babies and more moms are dying in childbirth.
I'm not sure I'm understanding what your point is here. With all the evidence pointing to primary c-section being less than ideal (what mother hopes for less than ideal for their child?), why shouldn't it be avoided? So many of the sections that are being done in the U.S. are preventable (I won't even call them unnecessary) with appropriate prenatal education, with correct and up to date information being presented to patients, with supportive staff who are willing to treat patients' preferences with deference, and so on.
I just watched the documentary "The Business of Being Born". I highly recommend it!