Why do you think some doctors are so anti-VBAC?

Phelia325

I encountered an ob (in a social setting) who was vehemently opposed to VBACs,  I want to believe that anti-VBAC doctors mean well, so I generally give them the benefit of the doubt that they are relying on outdated information.  However, this ob was relatively young (maybe late 40s).  I couldn't quite put my finger on the source of her animosity.  I understand that with a rcs, a doctor can have "more control" over the process.  But, statistically, there can be no dispute that rcs are not without risks.  I just don't get it.  What do you think the problem this?  And why does it become such a heated debate?

Phelia325

I wasn't sure about the profitability of a cs.  I know my cs cost a pretty penny, but the doc that performed my cs was part of a large university practice.  I don't know how the individual doctor's recoup.  I wasn't sure whether they were paid based on the expense of the procedure or whether they are simply paid for their on call time.

novilise

How much do c-sections typically cost out-of-pocket compared with vaginal birth or does it all depend on your insurance?

Three years ago, I paid about 1K for my unplanned c-section, but I don't know what I would have paid if I didn't have the surgery. I was expecting it to be alot more. 

My SIL had a vaginial birth without complications except they did have to make sure everything was okay because she has Grave's Disease and she paid lots lots more than me. It was weird.  All I could determine is that it was a difference in insurance companies.

MAprincess

I know that my CS cost 4x as much as my VBAC.  I paid the same out of pocket for both, so it was more money that the insurance company had to pay.

I agree with all of the possibilities already mentioned- easier/faster/more control on the end of the doctor.  I question the motives of any doctor who pushes the dangers of a VBAC without giving the same time and stress to the dangers of a CS.  Also, I question any doctor, no matter what their age, who can't be bothered with keeping up with the most current research in their field.

nosoup4u

That's so depressing about the OB you met!

Part of the big swing towards anti-VBAC was an ACOG bulletin ten years ago that said all VBAC women need to have a doctor and access to anesthesia for the entire duration of labor, which hospitals interpreted to mean 24 hours, which meant smaller hospitals started de facto VBAC bans (why a woman, who isn't attempting a VBAC, would want to labor in a hospital that doesn't have easy access to anesthesia just in case is beyond me, but I digress). The other big factor is that misuse of induction drugs and VBAC women in the 90s caused lots of ruptures, which also helped make doctors more leery of trying them. And I think the casual attitude that a c-section isn't a big deal is definitely taken as truth in our country right now.

All those things equal doctors who aren't friendly to VBAC. Even though from a public health standpoint, a 30+% c-section rate means more women and babies are at risk, and having higher VBAC rates as a way to lower the overall c-section rate benefits a lot more women and babies. </end rant>

Ready4life

The nurse at my OB office actually seems to be very pro VBAC when I had my 8 week appt. She gave me a brochure about it and talked like it was the best choice. At my 12 week appt, my Dr actually stated Pro's and Con's for me. He also said I can change my mind up until delivery. So I don't feel he is pressuring one way or another. But maybe I'm in the minority.

holly321

Ready4life:

The nurse at my OB office actually seems to be very pro VBAC when I had my 8 week appt. She gave me a brochure about it and talked like it was the best choice. At my 12 week appt, my Dr actually stated Pro's and Con's for me. He also said I can change my mind up until delivery. So I don't feel he is pressuring one way or another. But maybe I'm in the minority.

My ob said it would be the best choice for me too.

 

I think a lot of dr.'s are anti vbac due to insurance and liability.  And I think sometimes they don't have much say in their decision, their hospitals make the call for them.

nosoup4u

It's great you guys have found supportive doctors, but they really are the exception.The current VBAC rate is 8%.

BaumMom

My doctor mentioned that it is the hospital's policy (at one of the largest hospitals in Dallas, so its probably not uncommon) that my doctor has to be IN the hospital the entire time I am in labor. That means that if I go into labor in the middle of the night and labor for 36 hours, he has to be there the whole time whether he is on call or not. I can see how this would be a huge inconvenience to a doctor. I also think that the liability/insurance costs would be much higher and would cause doctors to be opposed to them. Luckily my doctor is willing to look past his own inconvenience. 

Phelia325

nosoup4u:

That's so depressing about the OB you met!

Part of the big swing towards anti-VBAC was an ACOG bulletin ten years ago that said all VBAC women need to have a doctor and access to anesthesia for the entire duration of labor, which hospitals interpreted to mean 24 hours, which meant smaller hospitals started de facto VBAC bans (why a woman, who isn't attempting a VBAC, would want to labor in a hospital that doesn't have easy access to anesthesia just in case is beyond me, but I digress). The other big factor is that misuse of induction drugs and VBAC women in the 90s caused lots of ruptures, which also helped make doctors more leery of trying them. And I think the casual attitude that a c-section isn't a big deal is definitely taken as truth in our country right now.

All those things equal doctors who aren't friendly to VBAC. Even though from a public health standpoint, a 30+% c-section rate means more women and babies are at risk, and having higher VBAC rates as a way to lower the overall c-section rate benefits a lot more women and babies. </end rant>

Your comments sort of mirrors what my OB explained at at today's appointment.  She explained that you need access to anesthesia and an OB 24 hours when attempting a VBAC (we are in NJ, not sure if state law comes into play) and many smaller hospitals and practices can't accommodate that.  Convenience does come into play with particular doctors, since some solo or smaller practices choose not to be available 24 hours.  I also asked about uterine rupture and she said that it was much more common in the 90s when they did 3d (3b?) inductions for VBACs.  She says the new VBAC guidelines do not advise aggressive inductions and are much less likely to result in ruptures.  I did ask whether monitoring could detect an imminent rupture and she said it could not.  However, at the 20 week scan they will look for uterine thinning.  She said recent studies do not suggest that scar examination (thinning or such) is indicative of a problem.  However, she said when the scar is undetectable on a scan, it's a good sign that the uterus has not been compromised.  I also asked about whether every doc in the practice is VBAC supportive and she assured me that they all her and many of the female docs, herself included, were VBAC patients.  So I am feeling pretty darn good about things right now!

Geekchick921

Phelia325:

Your comments sort of mirrors what my OB explained at at today's appointment.  She explained that you need access to anesthesia and an OB 24 hours when attempting a VBAC (we are in NJ, not sure if state law comes into play) and many smaller hospitals and practices can't accommodate that. 

This excuse from hospitals makes me SO mad.  WTF do they do with placental abruptions, cord prolapses, fetal HR crashes, etc?  It's the same excuse the hospital where I delivered DD gives but I also know that some of the staff that actually deals with risk and whatnot there thinks it's a total cop-out as well.

I think the doctors that are most vehemently anti-VBAC have likely experienced a bad outcome (a death or disability that probably led to a lawsuit as well) in the past that have made them unwilling to take another VBAC patient, which, if that were the case, I could understand.  I'd just want them to keep their mouths shut if they weren't my caregiver.  Undoubtedly, there are plenty of others that just don't want to be "bothered," too.

gemmaschenk

I personally think that it is just easier for some doctors to just say.."your having another c-section". I really don't understand what is doctor's problem when they are against it..I'm VERY happy to have a doctor who is up to date on all of his information and is more FOR me having a VBAC than I am..I'm a little nervous..but he knows that it is the best for me, as do I after researching it.

holly321

I find this inability to leave the hospital very interesting,

Makes me grateful my ob is a complete workaholic.  His nurse was telling me how he was disappointed I didn't deliver one weekend.  

novilise

Mummyofsix, I try to remember that, too....that some doctors might push it for convenience but others truly are worried. I know that in particular some doctors have seen VBAC's go badly for babies, so I think it can be hard for them to not just go in and do what they know....surgery...because that is slightly safer for baby. I guess if one of them has had a mom die during surgery, though, they may be one that might then push more VBAC's. I think sometimes it truly do have to do with human emotion and experience.