Tuesday, March 16, 2010


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.

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