Panel addresses cesarean and VBAC issues

VBACs (vaginal birth after cesarean, pronounced vee-back) are more difficult to achieve than you’d think. Where I live, there are 3 hospitals and only 1 allows VBACs (ironically, it happens to be the hospital where I was cut open). Within that hospital, there is only ONE clinic of doctors who will perform VBACs. Keep in mind I live in a fairly large city (population of 160,000 – and a total of 340,000+ if you include the smaller surrounding towns that most likely use our hospitals as well). This one clinic has 4 OBs (I think). That’s pretty sad, if you ask me. Makes my choices extremely limited for my next birth.

I completely understand the reason behind this: litigation. Not only are doctors afraid of this sue-happy nation, but their insurance companies urge them not to cover VBACs and some even threaten to drop them if they do perform them. What are they to do?

This past week, a panel of specialists convened by the National Institutes of Health met to discuss this very issue. They decided that VBACs should be an option, they urge that VBAC guidelines be revisited and malpractice concerns addressed, and stated that more research is needed.

Rigorous research shows that a trial of labor is successful in nearly 75 percent of cases.

One guideline they suggest needs revisiting is the one that says if there’s going to be a VBAC, the hospital needs to have an “immediate availability” of surgical and anesthesia personnel. This is not a feasible option in 30% of hospitals (according to 2 surveys) and was the reason they stopped offering VBACs.

VBAC remains a safe alternative for the right candidates, and when those women try labor, between 60 percent and 80 percent of the time they do give birth vaginally, the NIH panel concluded.

They want more research done so that each woman can be evaluated independently. What factors make VBACs more dangerous? less dangerous? This will hopefully allow more women the option to choose their birth.

The current overall cesarean delivery rate is 31 percent and the VBAC rate is less than 10 percent compared to 28 percent in 1996.

They are urging that doctors offer mother’s an unbiased look at pros and cons and let the mother decide for herself. The mantra used to be “once a cesarean, always a cesarean,” but research in 1980 concluded that VBACs were safe, as the risk of uterine rupture was less than 1%. After this, VBACs were on the rise. However, in 1996 things shifted back the other way. That guideline mentioned above (for the immediate surgery personnel on hand) was passed in 1999. Of 19 states that record VBACs, 92% of women had a repeat c-section in 2006. And the latest reason, of course, is fear of lawsuit.

Obviously I agree that it should be decided on a case-by-case basis. Some women are at a higher risk than others. But shouldn’t all of us at least get the choice? I’m not high-risk, but I will have to leap through flaming hoops on a flying monkey to get the VBAC I want in this city.

So it would seem I’m not crazy and c-sections ARE occurring too frequently. I am absolutely overjoyed that this conference just happened… 2 months after my birth experience. I am so glad they are working to do something about it.

You can find more information including their statements and reports on the NIH Conference website.

All quotes and stats used above are found in these 2 articles:
National Institutes of Health News
Associated Press

7 comments to Panel addresses cesarean and VBAC issues

  • Bobbi Janay

    I think every woman should have the option to choose.

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  • if I’m not mistaken… even though the hospital says they dont “allow” VBACS you can still demand 1 and get it. Since it all comes down to patient rights, they really have no say about it.

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  • Ohh that’s a good point Jennifer.. definitely something to look into. But.. I don’t know how comfortable I’d be going to a hospital that supposedly “doesn’t allow” VBACs, you know? I can’t imagine they’d be very friendly in helping me accomplish my VBAC goal. I’d imagine more of the same treatment I got.. being pushed into a c-section. I’d have to be really strong to get through that and I don’t want to “fight” through my next labor. KWIM?

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  • Vanessa

    I think as a society we have this idea that if we don’t push a baby out of our vay-jay-jay when we aren’t a “WOMAN.” That couldn’t be further from the truth. I endured 30+ hours of labor to only find out my pelvis was tilted and I would need a C-Section. I think if nothing else it made me a stronger woman because I endured so much pain (thanks to a non-working epidural) during labor and then during recovery from my c-section. The fact of the matter is what makes you a fabulous woman is your ability to raise and care for your child. No, it isn’t great to have a c-section and to think of the prospect of more c-sections for future children…but the end result is what should be focused on.

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  • Alice Anne

    I read an article I thought you might like called “Too Many Women Dying in U.S. While Having Babies”: http://www.time.com/time/health/article/0,8599,1971633,00.html#ixzz0hz6oVBwD

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  • Alice- thank you for sharing that! I am so glad this is starting to take headlines in the news.

    Vanessa- what’s weird is that feeling like less of a woman is not something I’m going through. I was cut open and I have a battle wound to show for it – I am one strong woman!! What upsets/depresses me is the experience that I missed out on.

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  • ashlie

    I was at a baseball game today (in St. Louis) and I happened to be sitting next to an OB from springfield, illinois. We started talking and I asked if I was a candidate for a Vbac (I’m not – I had a crash section with a classic incision, but she said her 1st baby was c-section and subsequent FOUR were Vbac. She said that all drs in her practice encourage when possible. Just wanted to pass along – made me think of you!

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