A Woman's Right to Push

   By drodriguez  Sep 14, 2008

There is much controversy surrounding the safety of VBAC (vaginal birth after caesarean), so much so that some hospitals are now refusing to admit women requesting this type of birth. A lot of hospitals and birthing centers started dropping their VBAC practices soon after the American College of Obstetricians and Gynecologists (ACOG) released a 1999 bulletin urging doctors to only perform a VBAC in a setting where proper emergency care is available.

According to an article published in the American Academy of Family Physicians (http://www.aafp.org/afp/990915ap/special.html) the ACOG still promotes the inclusion of VBAC as a birthing option, but it also takes the stance that no current or past study has proven that maternal and neonatal outcomes are better with VBAC than with repeat cesarean.

The American Academy of Family Physicians also provides a list that the ACOG gives to identify candidates for a VBAC:

- One or two previous low-transverse cesarean deliveries.
- Clinically adequate pelvis.
- No other uterine scars or previous rupture.
- Physician immediately available throughout active labor capable of  monitoring labor and performing an emergency cesarean delivery.
- Availability of anesthesia and personnel for emergency cesarean delivery.

One popular 2001 study published in the New England Journal of Medicine (http://content.nejm.org/cgi/content/short/345/1/3) concluded that women who chose to have a VBAC were at a higher risk of uterine rupture than those women who had planned cesarean deliveries. The study goes on to say that women who were induced using a prostaglandin (a cervical ripening agent) before their VBAC were at a much greater risk of rupture.

These findings, however, are very controversial because they only focus on uterine rupture. For example, the risks of having a second cesarean alone can range from severe infection to subsequent infertility. The findings give no information about other risks of cesareans versus VBAC.

The wide range of conflicting research, studies, and recommendations only add to the confusion of making such an important decision.

After doing the research then sitting down with physician and family, how does a woman decide?

Do you think doctors and hospitals should be required to perform VBAC if a woman has chosen it as her birthing option and is a viable candidate for the procedure?

(If you are thinking about having a VBAC, you can find an extensive list of support groups at http://www.vbac.com/supportgroups.html.)

Make a Comment

m121415 by m121415 | Glasgow, KY
Nov 13, 2008

Really like this blog! First birth, 1989, labored hard, 6'11 via natural birth Second birth, 1996, emergency C after labor trouble, 6'10 Third birth, 2005, FORCED vbac! I have complained and didn't care for the decision that was made for me and my husband, however I am proud and thankful to have 3 healthy boys today! :-)

caryn8 by caryn8 | LAKE GENEVA, WI
Aug 19, 2008

Just goes to show you that some women are feeling like they missed an experience with a c/section birth. Vaginal birth is the most natural experience a woman can have and some women want to experience it, even after a c/section. I say, talk with your doctor and furthermore educate yourself and make the decision that is best for you.

Betty2 by Betty2 | Arcadia, FL
Aug 11, 2007

In 1970 I HAD to have C/section with my son, because my pelvis wouldn't open. My son and bruises on his head where he had tried to come through. After 12 hours in labor, after my water broke...the doctor felt it was best to go with the emergency C/section.

Four years later, when my daughter was being born, the doctor told me that due to the high risk that was with my son, he felt a second c/section was the best way to go!

I am one that says...it depends on the circumstances of the first C/section...if there was a risky situation that created the need for C/section, and there is a HIGH risk factor with a VBAC...then I personally would go with C/section again!

shesamazingnyc by shesamazingnyc | New York, NY
Jul 25, 2007

I don't know about the rest of the country, but in NYC the average rate of C-sections is 30%. You cannot convince me that all those operations are necessary.

Do you know what failure to progress is? It is FEAR.

I too, was frightened when my labor started. Luckily I had a midwife who was patient and who I trusted with my life. I was in a birth center that allowed me to labor in peace, eat and drink when I wanted. I had the absolute conviction that I wanted a natural birth, and had I been any less confident, I would have succumbed to an epidural and the spiral that leads to C-sections. My second birth was incredibly fast and easy because I knew what to expect and I wasn't scared.

Women need support and less pressure to "produce."

Habegger4 by Habegger4 | Mount Hope, WV
Jul 01, 2007

With my first DD I had planned a natural unmedicated delivery due problems with anesthesia after previous surgeries. Ended up with an emergency c-sec for failure to progress. After 3 tries to get the spinal block started I had my beautiful baby. Second DD I had planned on a VBAC. Yes I felt like I missed out on giving birth vaginally, but also still to avoid the complications from anesthesia. Day after due date we decided it was probably time to deliver because my cervix was not opening. By the time they delivered her I had went from 2 1/2 cm to 6 cm in an hour time, but my daughter was 9 lbs. 10 oz. and they said my pelvis is shaped weird so I probably would not have delivered anyway. Again three tries for the spinal and I came home with a newborn and major headache from the spinal. Told DH if we have another one they are knocking me out. Keep in mind sometimes choosing VBAC isn't always for the baby or for the mother feeling like she is missing out. Mine main reason was for trying to avoid the complications. Anyway, just my two cents. And suggestion: Do what feels right for you and then find a doctor and hospital that will help you in that decision not fight you on it.

maricara12 by maricara12 | MINNETONKA, MN
Jun 28, 2007

What a great discussion. I had a VBAC after having a c-section with my first for "low amniotic" fluid. Both were healthy outcomes. I have 3 sisters who all had successful VBACS. VBACS are being discussed here as "the risk"- "why take the risk"? Nobody seems to mention the "risks" associated with C-sections. My question would be "Why take the risk with a c-section"? I didn't have a VBAC for some need to feel I went through natural childbirth- some people might feel that need.... I guess I can understand it. I did it, because from my research, the VBAC was actually lower risk than a repeat C-section. My Dr. was open to it, my hospital was open to it- and lastly, my family/husband and doula were open to it. All Dr's should be open to discussing options and presenting information to help mothers make informed decisions- not fearful ones. If you think that a planned C-section is the safest bet- please do more research to find out the facts... don't just take the word of your Dr. While they do have your interests in mind- they also have to keep in mind their malpractice insurance.... A uterine rupture is very unlikely... and can be monitored in a hospital with "walking telemetry".

TrishWahl by TrishWahl | amherst, OH
Jun 28, 2007

I just read the post about drs dont do c-sec just so they can get practice , no but they are doing them more and more to be on schedule for everyone they want to be able to plan around births anymore and that is just down right scarey

TrishWahl by TrishWahl | amherst, OH
Jun 28, 2007

My SIL had two VBAC's very close after her c=sec her babies are 3 yrs 2 yrs and one month all are well and there were no issues with either of the younger two. I wuld enocourage women to do what they feel is best them and their babies through much communication with thier OB and thier pediatrician ( the peds docs are full of valuable info for an expectant mommy

tmpinto by tmpinto | EDMOND, OK
Jun 27, 2007

I know C-sec is harder than a vaginal delivery, but why would you want to take ANY risk on delivering your unborn child?? Even if there is the smallest chance of something going wrong, it could happen. They don't reccomend it just so they can get practice doing c-sections!! They are actually doing what is best for your child!

gypsy4360 by gypsy4360 | ELEANOR, WV
Jun 26, 2007

I have already commented on this, but I must say one more thing. I hear everyone talking about the risk. And there is a risk, but it is a very small risk. Only 1 percent of those doing a v-bac end up with the uterine rupture. Of those who do rupture, only one percent of those babies don't make it. However, a natural child birth is healthiest for both mother and child. There is a reason why a child is supposed to go through the birth canal. I hate that I don't have a choice in this matter, but a women can choose to have an unneeded procedure for her own convienence. That is just WRONG!!!! Plus a planned c-section for no reason, is the cowards way out.

sharman421 by sharman421 | TALLAHASSEE, FL
Jun 25, 2007

Why would any woman want to take the chance? Weigh the evidence and do the right thing for yourself and your baby. Opting for caesarean for no medical reason in the first place is ridiculous. But if you have previously had to have a medically necessary c-section, why take the chance and have a vaginal birth? The baby's the thing! Not the way you delivered her.

Lovemiracle by Lovemiracle | Live Oak, TX
Jun 25, 2007

I had my only daughter via Emergency C-Section, and I'm planing on having one more child in the next couple of years, my choice this time it's a C-Section, I don't want to take chances or risk my health/life and my baby's life.

gypsy4360 by gypsy4360 | ELEANOR, WV
Jun 24, 2007

I had my first son via c-section, after 30 hours of labor. I really hated that. I pushed and tried, unmedicated, until they told me it was no longer safe for my son. Then I agreed to the procedure. I believe I actually mourned the fact that I could not birth my own child. 14 months later I was happily pregnant again. I searched low and high to find a dr. who would allow me to do v-bac. I was elated. Then at 23 wks, I found out I was having twins. My dr. backed out of the v-bac. No one else would take me. Short of having an unattended home birth, I had no other choice but to have another c-section. I knew that this would be my last pregnancy and my last chance for what I felt was a real birth. I will never be at peace with the fact that I had no choice of my own. I was forced into something that I didn't want or need. I feel like it is sheer laziness on the dr.'s part. He would have to be in the room doing his job for more than the average birth, and this is just asking to much. I hope in the future that this changes. It is a very unfair practice to deny a natural birth to any mother who feels like it is what she needs to do.

busytwinsmom by busytwinsmom | Upper Darby, PA
Jun 23, 2007

The reason the docs are so uptight about vbac is a missed diagnose or report by nurse of uterine rupture in its early stage..which doesn't last long, before it is deadly. I have had 2 c-sections, which were medically necesary: first one due to my cervix closing after dialation...second one due to a twin delivery with large twins. I think that before taking the risk, we should just ask why we want to go that way? Is it for the experience? Is it to compensate for that slight twinge of guilt that we feel for not delivering aux natural? Because both of these reasons are less important that the safest possible delivery of our babies, and the saving of our lives. There are lots of pains during labor. I pain in the side during a contraction that could be guesses as adhesions, just might be your babie's head popping out the side of your uterus, on the inside of your belly. I personally, don't feel comfortable taking this chance and I understand how a doctor wouldn't either.

MamiMari by MamiMari | Fresno, CA
Jun 22, 2007

Ladies we must all remember that no matter how your child arrives into this world, VBAC or C-section, the outcome is the same...we become mothers to a precious gift. I had an emergency C-section with my first child due to complications at 25 weeks. When i became pregnant w/ my 2nd i wanted a VBAC be/c i thought i had missed out on a rite of passage. LABOR. Every week for 32 weeks after i found out i was pregnant i had to be seen by the Dr and every week we discussed it-VBAC. In the end we scehduled an appt at 38 weeks to deliver my son. I never experienced my water breaking, labor pains, or yelling at my husband for doing this to me. Instead the day before my mom and I had a mother -daughter day at the Spa. I got my hair and nails done and a massage. The next day we took our kids (i have 2 stepsons and a girl) to stay with friends while my mom and hubby took me to the hospital. we unpacked and got settled. we were wheeled in, a local anesthetic was given and out he came. Half an hour later he was in my arms in my room. After it was all said in done, it didn't matter. My children were born and the only thing on my mind after that was enjoying them. But that is my story. Discussing with your doctor your capabilities and the risks to you and your child are key. Every woman is different and what may work for one may not necessarily work for another.