There are women who know these risks that the last two posts talked about, but they are with a Dr. who doesn't "allow" VBAC. Or, they are with a hospital that doesn't "allow" vbac. Austin's VBAC rate is 1%. Very low, and not enough, to me, to feel like I would have success in a hospital birthing. Some moms have then become pushed into a corner for homebirth. Personally, yes, this did influence my decision to HB. Also, I believe birth is an event our womanly bodies were designed for, and yes, there are things that can come up, and most of those can be solved by simply manuevers that a MW can perform. When it is out of her scope of practice, she has the means to stop the complication (like bleeding after birth)to give enough time to get to a hospital to receive medical help. Studies show, it's just as safe, if not safer than hospital birth. I personally didn't care for the stay I had in the hospital, it was weird, awkward, dirty, impersonal, rude, and something I don't think a new mom should have to go through or take her new baby through.
One woman at the conference said, with my first I was induced, it failed, I never dilated because my body was not ready for labor. I ended up with a c/s with my son. With my second pregnancy, the only thing I was told was at your 28 week appointment, make sure you schedule your c/s. I did, and we had a c/s. Now, with my third I am learning so much more. My Dr. put in my medical records that it was an "elective repeat cesarean section" (ERCS). I didn't "elect" to do it, I had no other option presented to me. There are 6 hospitals in my area and 1 birthing center. 3 of the hospitals and the birthing center have "banns" on VBACs, they don't "allow" them. The other two hospitals, that the closest is 2 hrs away, have a VBAC rate of 0.2%. So, yes, they do "allow" them, but my chances of birthing there successfully are almost nothing. If I have to, I'll homebirth, it's not the route I want to go, but I have no other choice.
This is so sad to me. First, women are induced, usually without medical reasons. I say this because when studied, induction IS NEEDED about 10% of the time due to health reasons. In Austin, for example, induction happens about 70% of the time. Elective inductions. And just to let you know, ACOG says DON'T DO THESE. They are too dangerous for mom and baby. You have to have true medical reasons for ending the pregnancy, like pre-eclapsia, severe gestational diabetes, baby life in threat or mom's life in threat. Just because your Dr. offers it, doesn't mean it is safe or recommended. This should be your first warning sign if your OB doesn't follow ACOG recommendations here.
Second, she was never told of VBAC. Simply told to schedule her CS. And then it was put down as "elective". Again, ACOG says to encourage VBAC in any mom with 1 low incision. Again, another sign if your Dr. doesn't promote VBAC, to get a new Dr.
Third, she now has just about no option but to HB if she wants a safer birth. VBAC compared to ERCS for the third time, is a hands down, safer route, especially if you want more kids. I think HB is a personally choice, and one should be very educated in choosing a caregiver that matches what they need and a support system that provides what they need. I don't think anyone should be backed into a corner and given HBAC (home birth after cesarean) as the only option. Sadly, this is what most women are faced with when they find out the facts of VBAC vs ERCS.
What is wrong with our society? There are seriously people who feel that c/s is safer than vaginal birth. They are few and far between, but most now feel that c/s is just as safe as vaginal birth. How arrogant of us humans to think we know how to do something better or as good as God designed the human body. Seriously, I think he knew what he was doing when he made us, and more importantly, there is a reason he did everything the way he did. Scientists, Doctors, Researchers are now finding out that labor is GOOD for the baby and for mom. Labor prepares the baby's lungs to breathe and pushes out the fluid in the lungs to air can come in at birth. The hormones that go one in labor get to the mom and baby, and have a dramatic effect on mom and baby bonding, which in turn, has effect on breastfeeding, postpartum mood disorders, both with mom and baby. Again, it's not a zipper that you can simply open and close with no risk to both parties.
Tuesday, March 16, 2010
NIH and VBAC
For those who don't know, the National Institute of Health met last week to come up with a consensus on VBAC (vaginal birth after cesarean). They met in DC, and thankfully, the entire conference was available to watch online. After almost 13 hrs of online watching, the finally came up with a decision that, yes, VBAC is safe, safer than ERCS (elective repeat cesarean section) and should be encouraged. This is the same conclusion they came up with back in 1980 and back in 1959 or so. As show, the studies repeat themselves, they show the same thing over and over, so for one to say, there are not enough studies on the safety, is bull.
Let me give you some info you may not have. The reason Dr.s are "scared" of VBAC is mainly due to uterine rupture, when the scar reopens during labor. This is studied to be less than 1% of a chance of happening. Induction and other factors increase these chances. There are no studies only looking at non-intervention moms, ie, no inductions, like cervical ripening agents, pitocin, prosteglandins, pain meds than inhibit mobility, etc. So you can imagine, that if you don't have those, or your caregiver doesn't supply those (like a midwife) then your risk is even lower.
Let's now take a look at other "risky" things in pregnancy and birth. ECV (external cephalic version) when the baby is breech and at 37 weeks they try to turn the baby to head down by pushing/turning on the mom's belly. This is done MANY time in the OB world, and nothing is thought of it. It holds a risk of more than 1% that the the baby will need to be delivered immediately like withing 20 min. The heart rate can plummet and the baby's life (>1% of the time) can be at serious risk. But this happens so infrequently, that it's deemed safer than an ERCS, and a way to opt to a vaginal birth.
Another, CVS testing (Chorionic villus sampling), is done around 11 weeks or so to test for the risk of downs syndrome. It's dome by a sampling the amniotic fluid and testing it. It's similar to amniocintesis only it can be done earlier. This carries a 1% chance of miscarriage. Yet, Dr. offer it to all women, and sometimes, encourage those with twins, advanced maternal age (which is greater than 35 btw, not less than that) or a family history that raises the risk. All of these are questionable reasons to have it done, but it's still a woman's choice. Keep in mind, a miscarriage this early, the baby doesn't survive. Now, with a uterine rupture that happens less than 1%, 6% of those babies will not make it. Yet, there is no fluff, or controversy about CVS, and the risks are rarely mentioned (it wasn't with me at least with Liam)
So, why is it that VBAC gets all this crap? Well, that was brought up numerous times, and the only answer besides 'we don't know' was 'malpractice'. "The only cesarean I got sued for doing was the one I didn't do". A common quote among OBs in the anti-VBAC world. While the average law suit in childbirth is rewarded $5 million, I can see how one would be "scared". Also, in some areas, like South Florida, (where the CS rate is up to 70% in some parts) malpractice insurance to cover the OB in these rare cases is now over $200,000 annually. That means an OB pays $200K for insurance for these just in case situations. If they opt to cover VBAC, their rates go up.
As you may see from my previous post VBAC is safer for mom by far. For baby, it's much safer. Maybe, just maybe in a highly medicalized birth with many interventions it's riskier for baby. But for me, even if I was having that type of birth, I'd still opt for VBAC. If the baby dies, yes, that is truly sad. He/She was a member of our family already, and now they are gone. But, if I DIE, which is 4 times more likely with a ERCS, I leave a husband, a son, family, friends, etc. So much more lost in their lives than than loosing the baby. Also, with each CS, the risk goes up more and more to seriously dangerous levels with subsequent CS. So if a mom has a CS with her first child, and then never allowed a VBAC, then her hopes for a large family should be seriously weighed, as the more CS, the higher the serious, life threatening complications are. With a third CS, the risk of all those hopes ending is a 1% chance, that is how common a hysterectomy is in a third time CS mom. But again, you never hear of OBs telling moms of these risks. That's sad.
Let me give you some info you may not have. The reason Dr.s are "scared" of VBAC is mainly due to uterine rupture, when the scar reopens during labor. This is studied to be less than 1% of a chance of happening. Induction and other factors increase these chances. There are no studies only looking at non-intervention moms, ie, no inductions, like cervical ripening agents, pitocin, prosteglandins, pain meds than inhibit mobility, etc. So you can imagine, that if you don't have those, or your caregiver doesn't supply those (like a midwife) then your risk is even lower.
Let's now take a look at other "risky" things in pregnancy and birth. ECV (external cephalic version) when the baby is breech and at 37 weeks they try to turn the baby to head down by pushing/turning on the mom's belly. This is done MANY time in the OB world, and nothing is thought of it. It holds a risk of more than 1% that the the baby will need to be delivered immediately like withing 20 min. The heart rate can plummet and the baby's life (>1% of the time) can be at serious risk. But this happens so infrequently, that it's deemed safer than an ERCS, and a way to opt to a vaginal birth.
Another, CVS testing (Chorionic villus sampling), is done around 11 weeks or so to test for the risk of downs syndrome. It's dome by a sampling the amniotic fluid and testing it. It's similar to amniocintesis only it can be done earlier. This carries a 1% chance of miscarriage. Yet, Dr. offer it to all women, and sometimes, encourage those with twins, advanced maternal age (which is greater than 35 btw, not less than that) or a family history that raises the risk. All of these are questionable reasons to have it done, but it's still a woman's choice. Keep in mind, a miscarriage this early, the baby doesn't survive. Now, with a uterine rupture that happens less than 1%, 6% of those babies will not make it. Yet, there is no fluff, or controversy about CVS, and the risks are rarely mentioned (it wasn't with me at least with Liam)
So, why is it that VBAC gets all this crap? Well, that was brought up numerous times, and the only answer besides 'we don't know' was 'malpractice'. "The only cesarean I got sued for doing was the one I didn't do". A common quote among OBs in the anti-VBAC world. While the average law suit in childbirth is rewarded $5 million, I can see how one would be "scared". Also, in some areas, like South Florida, (where the CS rate is up to 70% in some parts) malpractice insurance to cover the OB in these rare cases is now over $200,000 annually. That means an OB pays $200K for insurance for these just in case situations. If they opt to cover VBAC, their rates go up.
As you may see from my previous post VBAC is safer for mom by far. For baby, it's much safer. Maybe, just maybe in a highly medicalized birth with many interventions it's riskier for baby. But for me, even if I was having that type of birth, I'd still opt for VBAC. If the baby dies, yes, that is truly sad. He/She was a member of our family already, and now they are gone. But, if I DIE, which is 4 times more likely with a ERCS, I leave a husband, a son, family, friends, etc. So much more lost in their lives than than loosing the baby. Also, with each CS, the risk goes up more and more to seriously dangerous levels with subsequent CS. So if a mom has a CS with her first child, and then never allowed a VBAC, then her hopes for a large family should be seriously weighed, as the more CS, the higher the serious, life threatening complications are. With a third CS, the risk of all those hopes ending is a 1% chance, that is how common a hysterectomy is in a third time CS mom. But again, you never hear of OBs telling moms of these risks. That's sad.
Sunday, March 7, 2010
ICAN
ICAN stands for International Cesarean Awareness Network. It's for any mom who has had a cesarean and wants a vaginal birth, wants to avoid a cesarean, had a traumatic cesarean, or a cesarean that involved postpartum issues such as baby blues, insensitivity from others, depression, anxiety, further complications, etc.
I went to my first meeting on Saturday, and plan to continue to go through out my pregnancy and then be involved with this amazing community for the rest of my career. They meet the first Saturday of every month at the Carver Library in Central Austin. Our Doula happens to be the Austin spokesperson for ICAN locally. You can contact her through moonstonebirth.com, or through www.ican-online.org. ICAN is an outstanding resource for all moms and moms to be. Go to the ICAN website, and watch the video of their mission statement.
Basically, it's raising awareness of the over use of cesarean sections, and why that is dangerous, much more dangerous than vaginal births and how "elective" cesareans should be given with FULL INFORMED consent. Also, how a VBAC is substantially safer than repeat cesareans, especially if you have had more than one cesarean.
Here is some interesting stats for those curious of the difference for the maternal side:
VBAC (pronounced VEE-back)
success rate..................63.2% (2 in 3)
Risk of uterine rupture.......0.87% (1 in 115)
Risk of hysterectomy..........0.23% (1 in 435)
Risk of blood transfusion.....1.89% (1 in 53)
These stats are for a 1st VBAC, all subsequent VBACs the risks lower, and the success rates go up by about 10-20%. The risk of rupture is lower without the use of induction and augmentation, but sadly, there are no studies out there with this number, so if you avoid induction and augmentation, your risk is lower than that stated.
Now, let's compare that to a repeat cesarean: (definitions below)
2nd Cesarean
Risk of hysterectomy........0.42% (1 in 238)
Risk of blood transfusion...1.53% (1 in 65)
Risk of placenta accreta....0.31% (1 in 323)
Risk of major complications..4.3% (1 in 23)
Risk of dense adhesions.......21.6% (1 in 5)
3rd Cesarean
Risk of hysterectomy........0.9% (1 in 111)
Risk of blood transfusion..2.26% (1 in 44)
Risk of placenta accreta...0.57% (1 in 175)
Risk of major complications.7.5% (1 in 13)
Risk of dense adhesions....32.2% (1 in 3)
4th Cesarean
Risk of hysterectomy..........2.41% (1 in 41)
Risk of blood transfusion.....3.65% (1 in 27)
Risk of placenta accreta......2.13% (1 in 47)
Risk of major complications...12.5% (1 in 8)
Risk of dense adhesions.......42.2% (2 in 5)
Hysterectomy-The need and removal of the uterus
Blood transfusion-The need and procedure of giving the mother blood through IV after a hemmorhage
Placenta Accreta-when the placenta grows into the middle layer of the uterus, and removal become more dangerous usually leading to hemmorhage and need of blood transfusion.
Major complications-These include uterine rupture, hysterectomy, additional surgery due to hemmorrhage, injury to the bladder or bowel, thromboembolism (serious, life threatening blood clot), and/or excessive blood loss.
Dense Adhesions-When scar tissue forms and binds two layers of the body together that should remain separate, such as the uterus and the abdominal wall.
Not to mention, the increase in infection, postpartum mood disorders, cost, and longer recovery, etc.
That's not touching on the risks that increase for the baby, ESPECIALLY when a baby is born by cesarean section, before labor starts on it's own.
The lack of VBAC moms is arguably the main reason the cesarean section rate is too high. In a country with a cesarean rate now reaching 31.8% and a city with a rate nearing 40%, we need to be concerned that so many babies are being born through MAJOR abdominal surgery. The recommendation is for low risk moms to be around 10% and high risk around 15%. Yeah, we are WAY off. Regardless of what anyone may say, a cesarean is not "just another way for a baby to be born". IT'S NOT A ZIPPER!
Sadly, in Austin, the hospitals with the worst rates are the ones most used. These include Seton NW and St. David's South. One of the "better" hospitals to go to is North Austin Medical Center. This is mainly due to it being the only hospital in Austin that Midwives can assist in deliveries instead of OBs. Midwives statistically have lower CS, induction, episiotomy, augmentation, etc rates, as well as higher VBAC rates. But it all depends on your provider. You can have an OB who is better than some MW and/or a MW who is worse than some OBs. It's very important to INTERVIEW your care provider to make sure that their birth philosophy agrees with yours and their rates are where they are supposed to be. If your OB has a CS rate of more than 20%, induction more than 10% or offers induction when you don't have pre-ecclampsia or serious gestational diabetes or other health issues, switch providers.
I went to my first meeting on Saturday, and plan to continue to go through out my pregnancy and then be involved with this amazing community for the rest of my career. They meet the first Saturday of every month at the Carver Library in Central Austin. Our Doula happens to be the Austin spokesperson for ICAN locally. You can contact her through moonstonebirth.com, or through www.ican-online.org. ICAN is an outstanding resource for all moms and moms to be. Go to the ICAN website, and watch the video of their mission statement.
Basically, it's raising awareness of the over use of cesarean sections, and why that is dangerous, much more dangerous than vaginal births and how "elective" cesareans should be given with FULL INFORMED consent. Also, how a VBAC is substantially safer than repeat cesareans, especially if you have had more than one cesarean.
Here is some interesting stats for those curious of the difference for the maternal side:
VBAC (pronounced VEE-back)
success rate..................63.2% (2 in 3)
Risk of uterine rupture.......0.87% (1 in 115)
Risk of hysterectomy..........0.23% (1 in 435)
Risk of blood transfusion.....1.89% (1 in 53)
These stats are for a 1st VBAC, all subsequent VBACs the risks lower, and the success rates go up by about 10-20%. The risk of rupture is lower without the use of induction and augmentation, but sadly, there are no studies out there with this number, so if you avoid induction and augmentation, your risk is lower than that stated.
Now, let's compare that to a repeat cesarean: (definitions below)
2nd Cesarean
Risk of hysterectomy........0.42% (1 in 238)
Risk of blood transfusion...1.53% (1 in 65)
Risk of placenta accreta....0.31% (1 in 323)
Risk of major complications..4.3% (1 in 23)
Risk of dense adhesions.......21.6% (1 in 5)
3rd Cesarean
Risk of hysterectomy........0.9% (1 in 111)
Risk of blood transfusion..2.26% (1 in 44)
Risk of placenta accreta...0.57% (1 in 175)
Risk of major complications.7.5% (1 in 13)
Risk of dense adhesions....32.2% (1 in 3)
4th Cesarean
Risk of hysterectomy..........2.41% (1 in 41)
Risk of blood transfusion.....3.65% (1 in 27)
Risk of placenta accreta......2.13% (1 in 47)
Risk of major complications...12.5% (1 in 8)
Risk of dense adhesions.......42.2% (2 in 5)
Hysterectomy-The need and removal of the uterus
Blood transfusion-The need and procedure of giving the mother blood through IV after a hemmorhage
Placenta Accreta-when the placenta grows into the middle layer of the uterus, and removal become more dangerous usually leading to hemmorhage and need of blood transfusion.
Major complications-These include uterine rupture, hysterectomy, additional surgery due to hemmorrhage, injury to the bladder or bowel, thromboembolism (serious, life threatening blood clot), and/or excessive blood loss.
Dense Adhesions-When scar tissue forms and binds two layers of the body together that should remain separate, such as the uterus and the abdominal wall.
Not to mention, the increase in infection, postpartum mood disorders, cost, and longer recovery, etc.
That's not touching on the risks that increase for the baby, ESPECIALLY when a baby is born by cesarean section, before labor starts on it's own.
The lack of VBAC moms is arguably the main reason the cesarean section rate is too high. In a country with a cesarean rate now reaching 31.8% and a city with a rate nearing 40%, we need to be concerned that so many babies are being born through MAJOR abdominal surgery. The recommendation is for low risk moms to be around 10% and high risk around 15%. Yeah, we are WAY off. Regardless of what anyone may say, a cesarean is not "just another way for a baby to be born". IT'S NOT A ZIPPER!
Sadly, in Austin, the hospitals with the worst rates are the ones most used. These include Seton NW and St. David's South. One of the "better" hospitals to go to is North Austin Medical Center. This is mainly due to it being the only hospital in Austin that Midwives can assist in deliveries instead of OBs. Midwives statistically have lower CS, induction, episiotomy, augmentation, etc rates, as well as higher VBAC rates. But it all depends on your provider. You can have an OB who is better than some MW and/or a MW who is worse than some OBs. It's very important to INTERVIEW your care provider to make sure that their birth philosophy agrees with yours and their rates are where they are supposed to be. If your OB has a CS rate of more than 20%, induction more than 10% or offers induction when you don't have pre-ecclampsia or serious gestational diabetes or other health issues, switch providers.
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