Why so against VBAC?

cottonlily84

I never ever expected a c/s so I'm new to all this stuff.  I don't understand why some doctors only want women to have rcs, regardless of each individual case and circumstances.  What are the risks?  I've heard of rupturing but I don't see how you can carry a baby and stretch for 9 months fine but then rupture during delivery.  Is it the contractions or the pushing?  I haven't talked to my doctor about this yet because my yearly is not until April.  I just hope he doesn't have this attitude about it  - and doubt he does - because he's a great doctor and I do want to get pregnant again. 

honkytonk_kid

It's usually the additional pressure of contractions and pushing, although rupture is possible anytime during pregnancy. It's important to remember though, that the overall risk of ANY rupture is low, and the risk of catastrophic rupture (harm to mom or baby) is even lower.

Why so against it? Who knows. Personal biases, lack of updated information, convenience, etc. Many OBs are older, and practiced through an era of classical incisions, then using labor augmenting drugs on VBACs, both of which do lead to an increase in rupture rate. That's not an excuse for not updating knowledge, but it's a possible reason.

Anti-VBAC for all situations is just not a position that is supported by research. VBAC is a reasonable, reasonably safe option for many (most?) moms. RCS are also a reasonable, reasonably safe option, BUT they are not risk free, or even lower risk than VBAC.

MAprincess

Not sure why that is.  There are many catastrophic risks of c/s's but they don't seem to be bothered by that or bother to tell some patients about it.

I read somewhere that it is the legal risk.  More people sue if they or their baby are harmed during a vaginal delivery than if the mother or baby die during a c/s.  Apparently people see a c/s as a life saving event (even if it was an unecessary c/s that killed the mom/baby) while if the baby or mother dies during a vaginal delivery, it is a sign the doctor should have dne surgery.

That all may be true, but I always hope that it is just lack of educating themselves that causes them to make that choice.  It is bad enough that there is a recent study that showed that 2/3 of OBs make decisions based on anecdotal information rather than scientific facts.  I think the entire system needs an overhaul.

iris427

You should post this on the VBAC board. . We just had a good post about the risks of VBAC vs RCS.

Rupture risk increases during labor because of contractions.  But there is always a risk of rupture if you have had a prior cesarean.  Choosing RCS lowers that risk but does not erase it.

Back in the 80s or so, there was a big push to do VBAC in order to lower cesarean rates.  But VBAC was still "new" and doctors didn't know as much about it.  They didn't know that induction could increase the rupture risk, or a classical incision.  They didn't know how to screen for it as well.  People started having ruptures happen, lawsuits were filed, babies died, and there was a big anti-VBAC backlash rooted partly in litigation concerns and partly in fear.  C-section was touted as the safer alternative because people were not fully appraising the risks.  Hospitals and malpractice insurance providers began banning VBAC, further reinforcing the idea that it was dangerous and that RCS was the better option.  So a lot of doctors are either misinformed or they have been told they cannot do VBAC by their hospital or insurance provider.

cottonlily84

Sorry I didn't realize there was a VBAC section!  I will go there for sure.  I just wonder all this because I was so passionate about having a natural birth and really disappointed in the c/s.  It means alot to me to have a vaginal birth next time. 

Jessa1807

I think the fear of rupture is from contractions. But, many dr.s are against it because malpractice insurance is so high, and if something goes wrongs the dr will get blamed. I would highly rec finding a dr that is open to a vbac. Recovery is so much easier, and hospital stay can be much shorter. Do some research and be ready to talk openly about it with your. It is worth it!

danandbethg

Here in Las Vegas VBACs are practically banned. The only way you can VBAC (at least at the hospital I work at) is to have the doctor in house from the moment you arrive in the hospital til you deliver. And here that is unheard of. Doctors deliver at 2 or 3 different hospitals, all over the city. My doc delivers at 3. And her office isnt at the hospital I will deliver (and work) at. So, for me, a VBAC would absolutely not be an option. This is due to the risk (as low as it might be) of rupture. IF it would happen, my baby and I would both bleed to death long before my doc would arrive to stop it. We don't have residents, and there is no doctor constantly in house. The RNs work with mommies til they are about ready to deliver, then call the docs, who show up, deliver and baby and placenta, then leave. The nurses then clean you up. Not a safe place to attempt a VBAC.