A Woman's Right to Push

SS Member Image By drodriguez 09.14.08
A Woman's Right to Push
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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.)

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  • m121415 By m121415

    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

    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

    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

    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

    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

    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

    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

    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

    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

    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.

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