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.)

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Comments

by Rosycheeks | HOLLAND, MI

Jun 21, 2007

I had to have a cesarean too with my first born this past April. I was set to give birth vaginally, but after 20 hours of labor, the baby wasn't budging, his heartrate kept going up and down, the dr talked c-section and that's what we did. I was glad too for my baby's safety. I don't think I will take the risk of a VBAC and have a c-section again the next time around. I agree, it should be a decision left for the mother. We know our bodies and what they can handle. It's kind of weird, but I had a feeling that I would end up having a cesarean birth and I did.

by kabcat | Jonesborough, TN

Jun 20, 2007

I think that it should be up to the mother. I had my first child by cesarean due to not being able to dilate all the way but with my second child i tried VBAC but ended up not being able to dilate again i was in labor for a long time and ended up doing a caesarean, But i think that trying to do the VBAC after my first child was born was worth it even though i had to have the caesarean. As long as the baby isn't compromised it should be the mothers choice.

by tcarr01 | st. louis, MO

Jun 20, 2007

I attempted a VBAC after my first baby because I wanted to experience a natural birth and the caesaren was done because I had been in labor for 24hrs and never progressed past 6cm. It was important for me to at least try(didn't work) and my doctor understood that and actually encouraged it. I'm with the other women who believe that open communication with your Dr. is important. When I found out I was pregnant, the 2nd time, VBAC was one of the first things we discussed. Every situation is different and there may be medical reasons that your doctor feels strongly about, which supports his decision not to approve a VBAC. Everyone should approach the situation with an open mind to ensure that the BEST decision is made.

by twinmamma | Downingtown, PA

Jun 20, 2007

I think that with any medical care Dr./Patient communication is VITAL. Dr.s need to lay all of their concerns on the table and have the right 'plan B' in place with the patience understanding that if an emergancy were to come into play the Dr. can go to 'plan B'. However, the ultimate decision is the patients. I had a very successful vaginal birth with twins and understand the joy of giving birth, but also knew that at any moment my doctor could choose a c-section for the babies safety. An OB's job isn't just to protect the mother, it is to protect the child..

by cvarano | BROOKLYN, NY

Jun 19, 2007

It is definitely a decision everyone would have to make on their own. If it were me I would want to take no chances. I would just have another caesarean. It wouldn't be worth the possible risk to have a natural birth and either way I would have a beautiful healthy baby at the end of it all and that's the important part.

by tissakay | ROSE HILL, VA

Jun 18, 2007

As woman who has had four successful VBAC's after a ceseaean, I would have to encourage other women in this situation to try to find a dr who would at least be willing to allow them to attempt a VBAC.

I was very aware with each of my VBAC's that at any point if my Dr. felt a c-section was necessary that I would be taken to surgery.

Commnuncation between mother and Dr. is key!