CNN article on VBAC/HBAC

iris427

CNN has an article about a woman having a HBA3C and it's pretty good.  Of course they have to quote an OB saying it's dangerous and they talk about the risks of VBAC but gloss over the risks of repeat c/s.  But overall I think it shows VBAC and HBAC in a positive light.  Or maybe I'm just reading it like that because I'm pro-VBAC/HB!

 https://www.cnn.com/2010/HEALTH/12/16/ep.vbac.birth.at.home/index.html 

papagena

Read that earlier!  It was overall very positive (well, as positive as I've ever seen a homebirth national news story).

margeincharge2

I had to stop reading the comments. I think it's infuriating that she had to do an HBAC just to try a vaginal birth. That should be the focus of the article, not that she defied doctor's orders and had her baby at home. I can't say I would do that same but I think every woman should have access to a vbac in a hospital.

I am also getting sick of the emphasis on uterine rupture. The risk is 1%. The condition I had in pregnancy (HELLP) happens in about 1% of all pregnancies. Does that mean every pregnant woman should be running for the hills and scheduling c/s's because they could get HELLP too? It's frustrating.

ShansBride

I find it interesting that the docs are still defending themselves saying VBAmC is not "safe".  IMO, a 4th c/s is not safe either.  It makes me really sad that a woman who wants to push her baby out only has one option.  Not that HB is a bad option, but I don't think it should be her only one.

MrsAJL

margeincharge2:

I had to stop reading the comments. I think it's infuriating that she had to do an HBAC just to try a vaginal birth. That should be the focus of the article, not that she defied doctor's orders and had her baby at home. I can't say I would do that same but I think every woman should have access to a vbac in a hospital.

I am also getting sick of the emphasis on uterine rupture. The risk is 1%. The condition I had in pregnancy (HELLP) happens in about 1% of all pregnancies. Does that mean every pregnant woman should be running for the hills and scheduling c/s's because they could get HELLP too? It's frustrating.

Not for a VBAmC.  The risk for rupture during a VBAC after 2 c-sections can be as much as 3.7%, so the risk does increase.  Does that mean that women shouldn't have a safer option than HBA3C? No. They absolutely should, but the risks are real and while relatively low, the results are catastrophic in the event of a rupture.

I don't begrudge any woman a VBAC but I find home birth vaginally deliveries after multiple c-sections to be far, far more risky than a 4th repeat c-section. 

margeincharge2

MrsAJL:

margeincharge2:

I had to stop reading the comments. I think it's infuriating that she had to do an HBAC just to try a vaginal birth. That should be the focus of the article, not that she defied doctor's orders and had her baby at home. I can't say I would do that same but I think every woman should have access to a vbac in a hospital.

I am also getting sick of the emphasis on uterine rupture. The risk is 1%. The condition I had in pregnancy (HELLP) happens in about 1% of all pregnancies. Does that mean every pregnant woman should be running for the hills and scheduling c/s's because they could get HELLP too? It's frustrating.

Not for a VBAmC.  The risk for rupture during a VBAC after 2 c-sections can be as much as 3.7%, so the risk does increase.  Does that mean that women shouldn't have a safer option than HBA3C? No. They absolutely should, but the risks are real and while relatively low, the results are catastrophic in the event of a rupture.

I don't begrudge any woman a VBAC but I find home birth vaginally deliveries after multiple c-sections to be far, far more risky than a 4th repeat c-section. 

OK, fine. My reaction is to the fact that the comments to the article seem entirely anti-vbac. I just think the emphasis on rupture is entirely misplaced. There are so many risks involved in child birth. By those statistics, we should all just sign up for c-sections because *something* might go wrong. I don't see uterine rupture as any different from any other risk associated with vaginal childbirth. But yet it's held out there like the boogeyman going to get you.  

iris427

MrsAJL:

margeincharge2:

I had to stop reading the comments. I think it's infuriating that she had to do an HBAC just to try a vaginal birth. That should be the focus of the article, not that she defied doctor's orders and had her baby at home. I can't say I would do that same but I think every woman should have access to a vbac in a hospital.

I am also getting sick of the emphasis on uterine rupture. The risk is 1%. The condition I had in pregnancy (HELLP) happens in about 1% of all pregnancies. Does that mean every pregnant woman should be running for the hills and scheduling c/s's because they could get HELLP too? It's frustrating.

Not for a VBAmC.  The risk for rupture during a VBAC after 2 c-sections can be as much as 3.7%, so the risk does increase.  Does that mean that women shouldn't have a safer option than HBA3C? No. They absolutely should, but the risks are real and while relatively low, the results are catastrophic in the event of a rupture.

I don't begrudge any woman a VBAC but I find home birth vaginally deliveries after multiple c-sections to be far, far more risky than a 4th repeat c-section. 

It's hard to generalize about the risk level of VBAMC because studies are so contradictory about it.  But there are several studies determining that it's overall a safe and reasonable option.  Then we get into the debate of whether VBACs should be happening at home, but it was her only option and she had the right whether any of us think it was too risky or not.  A woman has the right to choose where and with whom she wants to give birth, even if her choice is one that most people would not like.

It's frustrating to me that so many primary cesareans don't need to happen in the first place but do because of our overly medicalized childbirth model.  And then once you have a scarred uterus, thanks to the overuse of medicine, you are expected to submit to even more medicalization for all future births, even if that's what caused the problem in the first place.  Or you will be labeled selfish and reckless.  Considering this woman's past births and the fact that pretty much no one would allow her to have a VBA3C in a hospital, I think her choice is understandable.

I also want to add that at least for VBA1C, a UR is not always catastrophic, thankfully.  A lot of scar ruptures are small and asymptomatic.  With timely cesareans, most ruptures can be addressed without any loss of life or permanent effects.  Occasionally there is a catastrophic rupture where even the resources of a hospital cannot save the baby or save the mother's uterus but thankfully that is rare.  Again, now we can debate whether there can be a timely cesarean if you have a UR at an HBAC, but a woman still has the right to consider that and choose to birth at home.  I'm fine with that.

iris427

margeincharge2:

OK, fine. My reaction is to the fact that the comments to the article seem entirely anti-vbac. I just think the emphasis on rupture is entirely misplaced. There are so many risks involved in child birth. By those statistics, we should all just sign up for c-sections because *something* might go wrong. I don't see uterine rupture as any different from any other risk associated with vaginal childbirth. But yet it's held out there like the boogeyman going to get you.  

I agree.  UR should be something that is discussed when someone is considering a VBAC, but I think it really gets played up unfairly.  For example, hospitals just wholesale banning any VBAC because they say they are not equipped to deal with UR.  But the risk of UR is about the same as the risk of having an obstetrical emergency in the general laboring population.  There's no difference between needing an emergency c/s for a cord prolapse and needing one for UR, at least from the logistical POV of having an OR staffed and ready to go round the clock.  A baby can die just as quickly from a cord prolapse or catastrophic placental abruption as it can from a bad UR.  So it's nonsensical to single out VBAC and tell women they are not allowed to have them.  There is obviously more to the story than just what is "safe" or what the hospital is equipped for.

JoelsGirl07

iris427:

margeincharge2:

OK, fine. My reaction is to the fact that the comments to the article seem entirely anti-vbac. I just think the emphasis on rupture is entirely misplaced. There are so many risks involved in child birth. By those statistics, we should all just sign up for c-sections because *something* might go wrong. I don't see uterine rupture as any different from any other risk associated with vaginal childbirth. But yet it's held out there like the boogeyman going to get you.  

I agree.  UR should be something that is discussed when someone is considering a VBAC, but I think it really gets played up unfairly.  For example, hospitals just wholesale banning any VBAC because they say they are not equipped to deal with UR.  But the risk of UR is about the same as the risk of having an obstetrical emergency in the general laboring population.  There's no difference between needing an emergency c/s for a cord prolapse and needing one for UR, at least from the logistical POV of having an OR staffed and ready to go round the clock.  A baby can die just as quickly from a cord prolapse or catastrophic placental abruption as it can from a bad UR.  So it's nonsensical to single out VBAC and tell women they are not allowed to have them.  There is obviously more to the story than just what is "safe" or what the hospital is equipped for.

iris - did I ever mention I love you? You take the words right out of my fingers (in this case)!

As someone who has chosen HB, I would like to relay the main thought I gave my mother that made her shut up about me being stupid: in a hospital, you are monitored by a machine. If you are lucky, someone is actually sitting at the desk watching 8-10 women's/babies' squiggly lines passing before their eyes. Otherwise they are waiting for something to beep. And because there are so many false beeps, it takes a few for them to register in your caregiver's brain (trust me, I ignore heart monitors a lot). 

With a HB, I have someone SITTING there, watching ME, the person. They are LISTENING to how I feel, and they know me and my body and trust me when I say something isn't right. I KNOW them and I trust them and am willing to ask if something is right or not because I am not embarrassed that it might be a stupid question. 

The first person to realize an impending rupture (I am obviously disregarding all the other catastrophic things that CAN happen - that's for another "rant") is the mother, not the machine.  She will feel it (if she is not numbed) and she or someone else will (hopefully) see the classic tugging band that preceeds a rupture on her belly. If those are detected, a call can be made to the hospital and she can be on her way.

THIS is why I am choosing to HB. 

**not trying to be mean or go crazy preggo on anyone, just trying to get the point across that choosing to HBAC is NOT a reckless choice***