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Birth & Beginnings: childbirth conversations

Hello mothers and mothers-to-be! This blog focuses on pregnancy, childbirth, children, and parenting. Along with providing helpful information and resources, it is also a place to discuss choices and trends in these areas. The blog will inform and encourage mothers as we share and learn from each other. It is not a place to say that one opinion is better than another; instead it is a forum for camaraderie and for sharing personal experiences. So feel free to read, respond, and absorb information on a daily basis as together we traverse this world of motherhood.

Laura Tolman, CCE, LSP

Laura Tolman is a local certified childbirth educator and labor support professional. She also works as a postpartum doula. She and her husband are long time Alaskans and are the parents and forming relationships with families while learning about other cultures. In her free time Laura enjoys writing freelance articles, poetry, and the performing arts. Her favorite pastime is being with family and coaxing uproarious laughter out of her young son.

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The Right to Choose a VBAC

Posted by mamas

Posted: April 18, 2008 - 10:46 pm

Vaginal Birth After Cesarean (pronounced Vee-back) draws a lot of controversy in the field of birthing professionals. Many mothers are being told that because they had a prior cesarean delivery, they can not or should not attempt a vaginal delivery. However, it stands to reason that the mother should have the right to be educated and to choose if she would like to have her subsequent children vaginally.

The main concern with VBAC is that a uterine rupture will occur during the process of labor and birth. This is a valid concern as a uterine rupture can constitute an emergency situation. However, recent research proves that in many instances it is in fact, safer for the mother and the baby alike to experience a vaginal birth instead of a cesarean. There are less medical and surgical risks, a shorter recovery, it is more cost effective, and there are numerous positive psychological factors that result from a VBAC as well.

There are some contraindications for VBACs to be aware of such as a classical uterine incision or a history of more than two previous cesarean births with no vaginal births. Also, many free-standing birth centers and midwives are no longer allowed to deliver VBACs in many states. Still, the current medical trend of repeat cesareans is taking a turn as more women request their own VBAC. If a woman who has had a c-section with a low transverse uterine incision would like to have a vaginal delivery with her subsequent children, it should not be discouraged.

If you are thinking about having a VBAC, it is important that the medical and birth team that you choose become a strong support network for you. Also good research and information is essential, along with finding a provider who has a high VBAC rate and who you feel comfortable with. The International Cesarean Awareness Network (I-CAN) website is a fabulous resource for those interested in VBAC and provides facts, tips, reading suggestions, and encouragement for the VBAC mom-to-be.

Recently the I-Can president released a statement that she is working to challenge the VBAC bans at hospitals in several states, one of which is Alaska. She is looking for women who have been denied a VBAC or are being told right now that they can not VBAC. If you are interested in helping with this cause, please e-mail I-Can president Pam Udy at president@ican-online.org and tell her your story.

Share your thoughts and stories concerning VBACs.

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7 July 3, 2008 - 9:39pm | aksurfmom

Are you being denied a VBAC?

Dear Friends,

As you are likely aware, many women are denied access to VBAC (Vaginal birth after cesarean) because of hospital policies and outright bans. Attorneys
with the Northwest Women's Law Center in Seattle are looking at this issue. She is investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states Alaska, Idaho, Montana, Washington and Oregon. If you are currently pregnant and want to have a VBAC, but are facing a hospital or insurance policy that would require you to have a c-section regardless of whether you want it and regardless of whether it isactually medically necessary, and you are willing to consider working with a lawyer on this, we'd like to talk with you. Please respond to:

vbacbanhelp@ican-online.org

6 June 12, 2008 - 12:03am | MehlerAK

Thanks!

I had a c-section with my daughter 4 months ago, and because this is such a hot topic, I have been researching my options as I would prefer to have a natural birth with my next kids. Thank you for all of the good resources, I will be using them!

June 24, 2008 - 11:11pm | mamas

You're Welcome

It takes a lot of courage and encouragement from others, but a VBAC is attainable and I'm glad that you're doing the research. Wishing you wonderful birthing experiences in the future!

5 May 27, 2008 - 10:30am | akvalleygirl74

I had a C with my first child

in the military hospital on Elmendorf 10 years ago, and then conceived twins 6 years later. My doctor that was a fertility dr knew I wanted to deliver at Prov and told me I had a choice to have a VBAC but said his advice would be to have a repeat C. I was given a choice, which I appreciated, but I was comfortable with having a C and scared of attempting a VBAC with twins since I didn't know if I would be successful and didn't want to recover from a vaginal birth (for the first time) AND a C if the second twin decided not to deliver vaginally for whatever reason.

I was active on a twins messageboard and have heard several stories of successful vaginal twin births, including VBACS. It's not common, but it can happen. I remember when I was having contractions at 37 weeks 2 days gestation, and the nurse (that I knew personally outside of the hospital) urged me to attempt a VBAC since the twins were head down and in the perfect position for it. I had an opportunity to change my mind and go that route but chose not to, based mostly out of fear of the unknown. But I will always appreciate my Dr giving me the option, because if I'd have chosen that route I feel confident he would have supported my choice despite his reservations about it.

May 29, 2008 - 10:04pm | mamas

Good to have a Choice

I am glad that you had a choice and it sounds like a supportive doctor as well. There are so many mothers who never experience either of these options. Thanks for sharing your story.

4 April 21, 2008 - 11:55am | ximi2003

My mom had a c-section when

My mom had a c-section when I was born and then she gave birth to two additional children naturally. She had many complications when she gave birth to me and it took her a long time to recover, but after the birth of my younger sister and brother she was out of the hospital in 3 days with no complications.
But this topic intrests me very much because my sister in law had a c- section with her first child and know her docter is telling her she should have her second child the the same way. I'm just curios as to why he is so persistent about her having a c- section again.

April 21, 2008 - 1:25pm | akvbacmom

Doctors Like c-sections.

Sometimes there is a medical reason for recommending a repeat c-section. However, I think much of the time there is not. Some doctors just like them.

It's more convenient for his schedule. He may make more money from a surgical delivery. He may be getting pressure from the hospital he has privileges at or even his malpractice insurer to push for repeat cesareans because the in the small chance that something goes wrong, they will be sued for not doing a c-section.

Has your SIL's doctor told her the risks of a repeat c-section? How about the risks of a third c-section if she should have another child after this one? The risks of things like hysterectomy, hemorrhaging, placenta problems etc. go up with each additional c-section a woman has. Babies born by scheduled c-section are at increased risk for respiratory distress and NICU admissions and even death over vaginally born babies.

IME, doctors like to caution on all the risks of VBAC while glossing over the risks of repeat cesareans.

If your SIL is interested in VBAC, you could point her to ICAN's website www.ican-online.org and also to Childbirth Connection's VBAC section http://childbirthconnection.org/article.asp?ClickedLink=293&ck=10212&area=27

She may also want to get a second opinion from another doctor or midwife.

April 21, 2008 - 2:10pm | mamas

Good Advice

I agree that there is occasionally a medical reason that would interfere with a VBAC. Unfortunately, a doctor often recommends a repeat cesarean for personal or insurance reasons.

I would suggest that your sister do some additional research. It may include talking to another provider as well. The ICAN website would be helpful for her. Also, there are some articles at about.com that might help. Here is the link to some stories from moms who tell their VBAC birth stories. It can really help pregnant women to hear from those who have successfully experienced a VBAC birth. Also, there is an interesting article that was published in USA Today about the VBAC controversy. The fact of the matter is, that a mother should be given a choice.

April 21, 2008 - 3:37pm | ximi2003

Thanks

I'll talk to her about it. When she calls cause she is also in Europe so I don't know what exactlly she can do , but I'm still going to talk to her about it cause last time she had a c-section they had to drain all thier accounts it cost so much.

3 April 20, 2008 - 4:42pm | roadfamily6now

VBACs!

This Article is great and could not come at a better time. I love Alaska but I am very saddened by the fact that Midwives are not allowed to take any VBAC clients for out-of-hospital births. :(
I have had very good VBAC experiences in the military hospital at Bassett and I was going to VBAC at Fairbanks Memorial Hospital last summer, so I know they still allow it.
I hope more people realize that ALL women should have a choice in how they birth. Women can choose to have a c-section for no reason, so conversly, other women should be able to choose to have a VBAC is they want to.

April 20, 2008 - 11:29pm | mamas

I agree

You hit the nail on the head. It's about women having the right to choose what kind of birth experiences that they want. Hopefully, we can help bring change to the Alaskan VBAC situation.

2 April 19, 2008 - 11:43am | akvbacmom

oh, and Thanks

For posting this info.

I'm pretty sure the Juneau hospital has a formal ban in place, I know other places essentially do because no doctors are willing to attend VBACs.

Bottom line is, they can't force you into sugery against your will. You have to consent. If a woman showed up in active labor at a hospital and refused a c-section. They couldn't legally operate.

Some useful info for how VBAC-friendly (or how high a c-section rate) for every hospital in Alaska can be found at http://www.hss.state.ak.us/dph/bvs/birth_statistics/Method_of_Delivery_Facility/frame.html
to calculate c-section rate you add the primary and secondary number and divide the sum of those two by the total # of births for any facility. That will give you the % of births that are a c-section. To calculate the VBAC rate, you would add the # of VBACs and the # of repeat C-sections then divide the # of VBACs by the sum of the two.

The statewide VBAC rate is 17.6% (in 2006)
Providence has a 19% VBAC rate
AK Regional has a 6.8% VBAC rate
ANMC has a 52% VBAC rate
Mat Su has a 16.2% VBAC rate

1 April 19, 2008 - 8:22am | akvbacmom

I had a VBAC

It was so much better than another c-section. It was safer for me and my son. It means I don't have more increased risk for a third pregnancy as each additional cesarean increases risks to future pregnancies

It wasn't the easiest thing to get either. I really appreciate all the support and information that I received from ICAN. I don't know if I could have done it without them.

Doctors (in general) do not like VBAC for a number of reasons and it really have very little to do with actual safety concerns. The risk of uterine rupture is 1 in 200 in a spontaneous labor. Induction/augmentation of labor raises the risk. The fear is liability if something goes wrong, the money, the requirement by their own trade union-The American College of Obstetricians and Gynecologists (ACOG) that the physician be "immediately available" at all times during a VBAC labor. That is usually interpreted to mean, they can't just show up at the end to deliver the baby, they have to be around the whole time the VBAC mom is laboring. Not convenient for them nor is the fact that induction increases the risk of UR so they can't just induce a mom to fit their schedule.

I had to fight and argue with various medical people throughout my pregnancy to get my VBAC. I educated myself extensively and I hired a doula and stayed home during labor as long as I felt birth was not imminent.

Barring health issues, my next child will not be born in a hospital. From what I hear, the VBAC climate in the hospitals here has just gotten worse since I had my son 4 years ago. Alaska makes this hard on me since they don't allow direct entry midwives to attend VBACs, but I will find a way regardless.

April 19, 2008 - 12:54pm | mamas

Thanks

Thanks so much for the information and for sharing your story. I'm sure that it will inspire other VBAC moms. Medical trends are difficult to deal with as a pregnant mom, yet the outcome can be very rewarding and beneficial.

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