More Business of Being Born: VBAC

So, as a normal healthy birth advocate, I feel it's necessary to bring up some things that people don't talk about. It is a controversial issue.... the issue of VBAC (vaginal birth after cesarean). I was recently watching More Business of Being Born, and they have a whole DVD devoted to VBAC. I was absolutely astounded by the information that was presented. It inspired me and I feel the need to share my thoughts on it.

*Just a quick note, I DO NOT judge women who have had cesareans (wether necessary or not) or women who choose to have a repeat cesarean. I understand that sometimes it is absolutely medically necessary to have a cesarean, and there are times when women do not want to attempt a VBAC or they are simply not a good candidate for a VBAC. Whatever the reason, I am in no way judging anybody. I am simply putting the information out there as something to think about... it's a very serious topic, and women need to know what options they have, and if they are a good candidate for a VBAC.*

As an aspiring birth doula, empowerment is my big thing... my "mantra" if you will... So naturally, I feel it's necessary that women feel empowered when they give birth, no matter which road they take. Women generally have an idea or vision of how they want their birth to go. Some of these visions may look like this: labor starts, pack the car, get to hospital and settle into the hospital room, labor beautifully with family and friends by your side (or just hubs and hospital staff), give birth either naturally or medicated to a beautiful baby and live happily ever after. I may be wrong, but I feel like unless a c-section is planned, most women probably don't go in expecting for their delivery to end with a cesarean. Just a thought...

Anyway, there are many reasons for this ridiculous rise in cesareans. Legal risks being the number one reason in my opinion. Dr.'s have to protect themselves from medical malpractice suits, so naturally they make the best decision they see fit for you and your baby should there be a medical emergency. But there are times when this is taken a little too far, and it's sad that Dr.'s have to walk on eggshells trying to do their jobs, but this is the reality. Dr.'s might deem your pelvis too small to birth a baby, or perhaps you've gone over your allotted "time limit," or maybe you've simply been pushing for too long or your baby is just "too big"... whatever the reason, women sometimes feel bullied into the OR. I have never had a cesarean, and hope to God that I never do, but this is just what I'm getting from the women that I've spoken to who have had cesareans and they don't know "why" or aren't sure they were sectioned for a valid reason.

It's just tough to say, and as humans we love to point fingers and pick out people to blame. I feel like nobody is really to blame but the people who invoke the fear into medical professionals... Really that's what it comes down to in my opinion. Why can't we just let Dr.'s be Dr.'s and let women be women and let them birth babies the way they want to? If only it were that easy.

Birth is normal and it's sad that when a woman chooses to have a VBAC it turns into this crazy situation that should never be treated anything but normal in the first place. At the end of MBOBB (More Business of Being Born... I'm going to use the acronym from here on out) they posted this little and very interesting tidbit: In 2010, ACOG (American College of Obstetrics and Gynecology) revised their Practice Bulletin, stating that more women should be considered appropriate candidates for VBAC including women with two previous cesareans and women carrying twins. Why is it still so difficult for women to have a VBAC?

Let's explore this a little bit... women who go to the Dr. during their subsequent pregnancy (or pregnancies) and present the desire for a VBAC either receive full support with a nice little disclaimer, or their Dr.'s simply won't even entertain the idea. (Some Dr.'s would love to allow VBAC's, but their insurance simply won't cover them during VBAC if they allow their patients to have one). Here's the disclaimer: You may attempt a VBAC but just know that there's a chance that your uterus will rupture killing both you and your baby. Okay... so lets take a look at these numbers. The risk of catastrophic uterine rupture is less than one percent. According to Pamela Paul, a journalist interviewed in MBOBB, only 1 in 2000 VBAC's result in catastrophic uterine rupture (meaning that mom dies, baby dies, or both die). 1 in 100 cases of uterine rupture aren't even discovered until after the fact... meaning it's literally just a tiny tear in the uterus. So let's go back to the first stat... 1 in 2000 VBAC's result in catastrophic uterine rupture... Did you know that the risk of killing a baby doing an amniocentesis is way higher than having catastrophic results from a VBAC? Yeah.. neither did I because women do them ALL THE TIME. Pamela Paul stated that the risk of fetal death from an amnio is 1 in 200-400 cases. WAYYYY higher than a bad outcome from a VBAC. Just something to think about....

Just a few other interesting tidbits: According to Pamela Paul, in the 1990's VBAC rates went up to as high as 28%. Today, 8% attempt a VBAC, and about 75% of those who make an attempt have a successful VBAC. That's a large number of successful VBAC's!! However, 90% of pregnant women just go for a repeat c-section. So then if you look at the risks of having a repeat c-section, it just gets worse with every cesarean. It's just crazy. Just to spare any of you moms out there reading this who have had more than one section, or are going in for another even after two or more previous sections, I will not include the horrifying risks that increase after each section. I will say, that in the last 30 years placenta accreta has increased 30 fold. You can research it on your own if you like, this information is courtesy of MBOBB and from what they've conveyed about it, this is a life threatening condition.

So given these statistics and given that even in the best of circumstances, why is it so hard to get a VBAC? Hospitals can handle all sorts of traumas but not a VBAC? Something really needs to happen here because in my opinion this just goes all the way back to medical malpractice insurance dictating the way Dr.'s can practice and I think that is just plain wrong. Maybe I'm wrong or my information is off, but that's just the way I see it. Women need to have the opportunity to have the birth they desire, and Dr.'s need to be able to practice medicine without fear of being held liable for something that should be considered completely normal and natural. As stated by Dr. Stuart Fishbein, OB/GYN, they're trying to prevent bad outcomes by preventing choice. He also noted that of women who have a successful VBAC, the complication rate for mothers is less than repeat c-section. Interesting thought.

As far as those women who do suffer catastrophic results from VBAC, I think it's important to note wether or not that woman was a good candidate. According to Dr. Suzanne Gilberg-Lenz, OB/GYN, women who had a breech baby and had a c-section, or women who had ruptured their membranes at 36 weeks and ended up with a c-section are actually very good candidates. Again, very interesting.

What's important here is that it is crucial that women think about this before they get pushed into a decision they may regret later. Women do have options in most cases, and they need to look into them. A lot of midwives will accept VBAC clients... but ultimately, all of this information is useless if the expectant mother does not have the desire to VBAC. That's totally okay!! Some women are totally fine with doing repeat c-sections and that is just fine. BUT, the fact of the matter is, women who want to VBAC and do things as naturally as possible, should have the right to do so or at least be given the opportunity to try if they are deemed a good candidate. And again, I can't stress this enough, a woman needs to have a whole hearted desire to VBAC. This is the only way she will be given an opportunity or even have a slightest chance at success.

I'm going to make one last little note here... I had absolutely NO intention of scaring the wits out of anyone who decided to read this, so I left out a few things that weren't completely necessary to include because I feel like anyone researching this topic would know about all of the scary complications from cesareans. I just learned all of this as I watched More Business of Being Born and I felt the need to put it out there. I know a lot of women who've had c-sections and I doubt they knew any of this information or even thought they may have any options for their next delivery/deliveries. (If you did happen to know all of this information, that's fabulous I'm glad you did your research!!). If I upset you, I apologize. If my facts are wrong, please feel free to correct me. I'm always interest in learning the facts, but from what I've read and researched on my own, I've really come to trust the information in the Business of Being Born documentaries. I recommend them to everyone!! Again, my apologies to anyone who may find anything in my blog offensive. I just really felt it on my heart to lay this all out. :)