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rayskit10
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TIME Article: The Trouble with Repeat C-Sections
rayskit10
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https://www.time.com/time/magazine/article/0,9171,1880665-2,00.html
For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car."
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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.
Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.
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.
So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.
But many interpreted the revision to mean that surgical staff must be present the entire time a VBAC patient is in labor. While major medical centers and hospitals with residents are staffed to provide this level of round-the-clock care, smaller hospitals typically rely on anesthesiologists on call. Among obstetricians, many solo practitioners are unable to stay for what could end up being a 24-hour delivery; others calculate the loss of unseen patients during that time and instead opt to do hour-long cesareans, which are now the most commonly performed surgeries on women in the U.S.
Some doctors, however, 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. (See 9 kid foods to avoid.)
Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."
Of course, the alternative to a VBAC isn't risk-free either. With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.
"The decline in VBACs is driven both by patient preference and by provider preference," says Dr. Hyagriv Simhan, medical director of the maternal-fetal-medicine department of Magee-Womens Hospital of the University of Pittsburgh Medical Center. But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." 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.
Zelop is among those who worry that "the pendulum has swung too far the other way," but, she says, "I don't know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid." So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: "When the problems with multiple C-sections start to mount, we're going to look back and say, 'Oh, does anyone still know how to do VBAC?'"
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Re: TIME Article: The Trouble with Repeat C-Sections
Interesting. My doctor and I discussed the VBAC option when I had Kaitlyn... However due to the issues with my failure to progress with Micaela, he felt it was in my and the baby's best interest to have another c-section. I'm sure he'll feel the same with any others. I do often worry though... If we wanted to have 2 more kids, is a cesarean really the best way to go? :?
I think my experience the first time around also had a lot to do with me going with the flow on the 2nd. After 52 hours of labor, the last 12 or so of hard labor wiht NO dialation and several scares due to her heart rate falling, I had no issues whatsoever walking in for a scheduled c-section. lol I wonder if this isn't the case for some women also.
Very interesting!
My doctor said that he is one of the few doctors that do VBACs. which is sad. Especially for a patient like me -- the classic VBAC case in his opinion (an already successful vag birth and c-section due to positional reasons). I hate to think of all the unnecessary sections.
VBAC all the way for me next time. As long as that peanut turns around. I would switch doctors if he didn't agree with me.
well, i think the point is that there are a lot of women who would be perfectly fine having a VBAC but Drs won't do them for fear of lawsuits. my own doctor said this to me- she is one of only a few OBs in HOuston that will do them and she said she does b/c she runs her practice based on medecine, not fear of lawsuits. clearly there are reasons to have csecs and the article isn't implying that a VBAC is right for every person, every time. but they are trying to make the point that multiple csects have risks of their own, as high a percentage as VBACs, yet doctors push cs and don't offer VBACs as an option.
i am *trying* for a VBAC with Twosey, but know very well that if my pregnancy ends anything like it did with Turtle, VBAC will not end up being an option. neither my OB nor i am VBAC at all costs, but i am so happy to at least have the option ahead of me at this point.
there is a link in the article about elective c-sections that has some disturbing stats as well (again, it's not saying c-sects are bad, but it's saying that the number of women putting sheer convenience over their baby's needs is starting to cause medical issues)
That's really interesting information. After reading it I feel very fortunate to have had two vaginal deliveries. I know I've posted this link on these boards many times before, but here it is again:
https://www.newyorker.com/archive/2006/10/09/061009fa_fact
This really interesting article in the New Yorker magazine traces the history of obstetrics and the c-section in particular. The article links the rise in c-section rates in this century to the development of the APGAR score. It's super long but fascinating.
I thought it was really strange in the hospital when all the nurses who found out I had a c-sec said "now you can schedule your next babies birthday!" I had no idea VBACS weren't common at the time. My sister had her first via c-sec, her next two were VBAC. But every nurse said, oh no, you'll have a c sec for the next one.
My birth was similar to Darvas. Long labor, I did progress, but she didn't come out. She would come down and go back up over and over. Heart rate would drop, I'd get oxygen and we'd start again. I was glad to have the c-sec to have a healthy baby. Apparently I'm not a candidate for a VBAC for many other reasons.
However, what suprises me is I keep hearing you can only have 3 or 4 uterine surgeries, including c-sec. Which would mean if you couldn't do a vbac you can only have 3-4 kids? Has anyone else heard that?
If your OB does vbacs - what's their name?
I've been looking at the information from ICAN and I got some names from MDC, but I'd love to get a recommendation.
And if they do vbacs, what hospital do they deliver at? Because I understand that some hospitals simply won't allow them.
j+k+m+e | running with needles
Dr Geffrey Klein of OGA Webster. He delivers at Clear Lake Regional Medical Center.
Not sure where you are located. But I lurve him. He's fab.
Hmm. I've never heard that but I guess that was what I was getting at earlier... Is there a limit? If so, Chad better hope the next one is a boy! lol I'll bring it up again with my doc and we'll see what he says. Maybe as a policy he doesn't do them, but that's not what he's telling me. I don't really see him doing that though, he's always been a pretty up front doctor with issues, etc that I've had in the past. I don't know... Gives me something to debate with him next time I go in.
She's likely way too far away for you, but Dr. Jane Reed at Specialists for Women in The Woodlands did my VBAC. I delivered at Memorial Hermann - The Woodlands, but I think she also has privileges at St Luke's - The Woodlands.